Provider Demographics
NPI:1255315792
Name:KOURAJIAN, STEVEN CHARLES (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:CHARLES
Last Name:KOURAJIAN
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 1:901 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:ND
Mailing Address - Zip Code:58341-1523
Mailing Address - Country:US
Mailing Address - Phone:701-324-2154
Mailing Address - Fax:701-324-2160
Practice Address - Street 1:901 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:ND
Practice Address - Zip Code:58341-1523
Practice Address - Country:US
Practice Address - Phone:701-324-2154
Practice Address - Fax:701-324-2160
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDND408152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND4085520001Medicare NSC
NDT66895Medicare UPIN