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General NPI Number Information
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NPI Number | 1801537691
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Entity Type | Individual
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Provider Name | SERINE MKRTCHYAN DOCTOR OF OPTOMETRY
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Gender | Female
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Dates
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Enumeration Date | 04/05/2022
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Last Update Date | 10/06/2023
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Provider Practice Location Address
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Address Line | 10605 BALBOA BLVD STE 230
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City | GRANADA HILLS
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State | CA
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Zip | 91344-6344
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Country | US
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Telephone | 818-368-4114
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Fax |
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Provider Business Mailing Address
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Address Line | 8556 GULLO AVE
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City | PANORAMA CITY
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State | CA
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Zip | 91402-4048
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Country | US
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Telephone | 818-573-4867
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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 | 35118
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License Number State | CA
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