MEDICARE: DR. STEVEN CHARLES KOURAJIAN 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	ND408	ND

General Provider Information

NPI Number	:	1255315792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN CHARLES KOURAJIAN O.D.

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	10/23/2007

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