MEDICARE: STEVEN C. KOURAJIAN, O.D., P.C.

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	ND 408	ND

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
2	01625001	OTHER	ND	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1053591537
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEVEN C. KOURAJIAN, O.D., P.C.

Provider Business Mailing Address
First Line	:	901 LINCOLN AVE
Second Line	:
City	:	HARVEY
State	:	ND
Zip	:	58341-1523
Country	:	US
Telephone Number	:	701-324-2154
Fax Number	:	701-324-2160

Provider Business Practice Location Address
First Line	:	901 LINCOLN AVE
Second Line	:
City	:	HARVEY
State	:	ND
Zip	:	58341-1523
Country	:	US
Telephone Number	:	701-324-2154
Fax Number	:	701-324-2160

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. STEVEN CHARLES KOURAJIAN
Credential	:
Telephone Number	:	701-324-2154

Provider Enumeration Date	:	11/13/2007
Last Update Date	:	01/18/2008

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