Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | SLD42161 | CA |
NPI | 1194495465 |
---|---|
Provider Name | Sarkis Khotsuryan |
First Address | Woonsocket, RI 02895 |
Second Address | Burbank, CA 91506-2150 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2021 |
Last Update Date | 17/09/2021 |