Provider Demographics
NPI:1053493759
Name:KAZARIAN, NICK C (OD)
Entity Type:Individual
Prefix:
First Name:NICK
Middle Name:C
Last Name:KAZARIAN
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 1:5786 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA07240-T152W00000X
CA07240T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA45386OtherSAFEGUARD VISION HMO PLAN
CA02220OtherMEDICAL EYE SERVICES
CA211379OtherEYEMED VISION PLAN
CA49815OtherSAFEGUARD PPO PLAN
CASD0072400Medicaid
CA211379OtherEYEMED VISION PLAN
CAT10498Medicare UPIN
CA0235020001Medicare NSC