Provider Demographics
NPI:1386753275
Name:KOURY, EUGENE M (OD)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:M
Last Name:KOURY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6009 PENTZ RD
Mailing Address - Street 2:BLDG A
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-5542
Mailing Address - Country:US
Mailing Address - Phone:530-899-2244
Mailing Address - Fax:530-899-9331
Practice Address - Street 1:6009 PENTZ RD
Practice Address - Street 2:BLDG A
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-5542
Practice Address - Country:US
Practice Address - Phone:530-899-2244
Practice Address - Fax:530-899-9331
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4836152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT76543Medicare UPIN