Provider Demographics
NPI:1891569356
Name:BOULGOURJIAN, ALIQUE (OD)
Entity Type:Individual
Prefix:DR
First Name:ALIQUE
Middle Name:
Last Name:BOULGOURJIAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4353 PARK TERRACE DR STE 150
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-4639
Mailing Address - Country:US
Mailing Address - Phone:805-987-5300
Mailing Address - Fax:818-707-7668
Practice Address - Street 1:4353 PARK TERRACE DR STE 150
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-4639
Practice Address - Country:US
Practice Address - Phone:805-987-5300
Practice Address - Fax:818-707-7668
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-14
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35606152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty