Provider Demographics
NPI:1881583888
Name:KAVALCHUK, KATSIARYNA (OD)
Entity type:Individual
Prefix:
First Name:KATSIARYNA
Middle Name:
Last Name:KAVALCHUK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 NORWAY AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-1030
Mailing Address - Country:US
Mailing Address - Phone:917-930-4344
Mailing Address - Fax:
Practice Address - Street 1:187 AVENUE U
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-3741
Practice Address - Country:US
Practice Address - Phone:718-373-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPENDING152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty