MEDICARE: DR. YERANUI ERIN GEZUKARAYAN 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	152W00000X	Optometrist	13502	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	13502	OTHER	CA	CALIFORNIA STATE BOARD OF OPTOMETRY LICENSE

General Provider Information

NPI Number	:	1184880247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YERANUI ERIN GEZUKARAYAN OD

Provider Business Mailing Address
First Line	:	10620 WILSEY AVE
Second Line	:
City	:	TUJUNGA
State	:	CA
Zip	:	91042-1643
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2195 GLENDALE GALLERIA
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91210-2101
Country	:	US
Telephone Number	:	818-334-1402
Fax Number	:

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

Provider Enumeration Date	:	07/29/2008
Last Update Date	:	05/27/2019

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