MEDICARE: NICK C KAZARIAN O.D.

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	152W00000X	Optometrist	07240-T	CA
2	152WC0802X	Corneal and Contact Management Optometrist	07240T	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	45386	OTHER	CA	SAFEGUARD VISION HMO PLAN
2	02220	OTHER	CA	MEDICAL EYE SERVICES
3	211379	OTHER	CA	EYEMED VISION PLAN
4	49815	OTHER	CA	SAFEGUARD PPO PLAN
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053493759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICK C KAZARIAN O.D.

Provider Business Mailing Address
First Line	:	5786 S ELM AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93706-5813
Country	:	US
Telephone Number	:	559-486-0731
Fax Number	:	559-486-0122

Provider Business Practice Location Address
First Line	:	5786 S ELM AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93706-5813
Country	:	US
Telephone Number	:	559-486-0731
Fax Number	:	559-486-0122

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

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	12/19/2011

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