MEDICARE: LINA MANOUKIAN OD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	152W00000X	Optometrist	OPT33942TLG	CA

General Provider Information

NPI Number	:	1144711177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINA MANOUKIAN OD

Provider Business Mailing Address
First Line	:	5818 SANTA MONICA BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90038-2002
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5818 SANTA MONICA BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90038-2002
Country	:	US
Telephone Number	:	323-762-2294
Fax Number	:

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

Provider Enumeration Date	:	05/25/2018
Last Update Date	:	08/11/2022

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