Provider Demographics
NPI:1487228466
Name:SAHAGIAN, LUSAPER LUCY (OD)
Entity Type:Individual
Prefix:DR
First Name:LUSAPER
Middle Name:LUCY
Last Name:SAHAGIAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LOSABIR
Other - Middle Name:
Other - Last Name:ISHAKIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19 HARNDEN AVE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-3201
Mailing Address - Country:US
Mailing Address - Phone:617-458-9277
Mailing Address - Fax:
Practice Address - Street 1:1 WASHINGTON ST STE 304
Practice Address - Street 2:
Practice Address - City:WELLESLEY HILLS
Practice Address - State:MA
Practice Address - Zip Code:02481-1706
Practice Address - Country:US
Practice Address - Phone:781-235-5100
Practice Address - Fax:781-235-2444
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-14
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MA5470152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program