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General NPI Number Information
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NPI Number | 1295258465
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Entity Type | Individual
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Provider Name | KIA BOROUMAND OD
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Gender | Male
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Dates
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Enumeration Date | 07/19/2017
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Last Update Date | 10/13/2021
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Provider Practice Location Address
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Address Line | 414 W HIGH ST
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City | EBENSBURG
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State | PA
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Zip | 15931-1584
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Country | US
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Telephone | 814-472-4240
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Fax |
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Provider Business Mailing Address
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Address Line | 203 OAK EDEN DR
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City | JOHNSTOWN
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State | PA
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Zip | 15904-1865
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Country | US
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Telephone | 814-248-1812
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OEG003313
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License Number State | PA
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