MEDICARE: LUSINE VARDANYAN OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152WC0802X	Corneal and Contact Management Optometrist	33978TLG	CA
2	152WP0200X	Pediatric Optometrist	33978TLG	CA
3	152W00000X	Optometrist	33978TLG	CA

General Provider Information

NPI Number	:	1154807345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUSINE VARDANYAN OD

Provider Business Mailing Address
First Line	:	1112 W BURBANK BLVD STE 204
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91506-1455
Country	:	US
Telephone Number	:	818-846-9075
Fax Number	:

Provider Business Practice Location Address
First Line	:	1112 W BURBANK BLVD STE 204
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91506
Country	:	US
Telephone Number	:	818-846-9075
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2018
Last Update Date	:	01/09/2019

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Directions to “ LUSINE VARDANYAN OD” Practice Location

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