MEDICARE: MS. KARINA MANUKYAN OPHTHALMIC DISPENSER

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	156FX1100X	Ophthalmic Technician/Technologist	31TD00373000	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306130638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KARINA MANUKYAN OPHTHALMIC DISPENSER

Provider Business Mailing Address
First Line	:	1 SPRING ST
Second Line	:	UNIT 101
City	:	NEW BRUNSWICK
State	:	NJ
Zip	:	08901-2276
Country	:	US
Telephone Number	:	732-246-6895
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 SPRING ST
Second Line	:	UNIT 101
City	:	NEW BRUNSWICK
State	:	NJ
Zip	:	08901-2276
Country	:	US
Telephone Number	:	732-246-6895
Fax Number	:

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

Provider Enumeration Date	:	06/03/2011
Last Update Date	:	06/03/2011

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