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General NPI Number Information
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NPI Number | 1154807345
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Entity Type | Individual
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Provider Name | LUSINE VARDANYAN OD
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Gender | Female
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Dates
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Enumeration Date | 07/11/2018
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Last Update Date | 01/09/2019
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Provider Practice Location Address
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Address Line | 1112 W BURBANK BLVD STE 204
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City | BURBANK
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State | CA
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Zip | 91506
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Country | US
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Telephone | 818-846-9075
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Fax |
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Provider Business Mailing Address
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Address Line | 1112 W BURBANK BLVD STE 204
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City | BURBANK
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State | CA
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Zip | 91506-1455
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Country | US
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Telephone | 818-846-9075
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 33978TLG
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | 33978TLG
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 33978TLG
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License Number State | CA
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