Provider Demographics
NPI:1427244292
Name:NICK C KAZARIAN
Entity type:Organization
Organization Name:NICK C KAZARIAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:C
Authorized Official - Last Name:KAZARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:559-486-0731
Mailing Address - Street 1:5786 S ELM AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93706-5813
Mailing Address - Country:US
Mailing Address - Phone:559-486-0731
Mailing Address - Fax:559-486-0122
Practice Address - Street 1:5786 S ELM AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-5813
Practice Address - Country:US
Practice Address - Phone:559-486-0731
Practice Address - Fax:559-486-0122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA07240-T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA02220OtherMEDICAL EYE SERVICES
CASD0072400Medicaid
CA45386OtherSAFEGUARD VISION
CA211379OtherEYEMED VISION
CA0235020001Medicare NSC
CA211379OtherEYEMED VISION
CASD0072400Medicare PIN