Provider Demographics
NPI:1942975982
Name:KOCHKARIAN, YERAZ ANI (OD)
Entity Type:Individual
Prefix:
First Name:YERAZ
Middle Name:ANI
Last Name:KOCHKARIAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1168 CONCORD ST
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2257
Mailing Address - Country:US
Mailing Address - Phone:818-641-6404
Mailing Address - Fax:
Practice Address - Street 1:1046 W AVENUE K
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-5918
Practice Address - Country:US
Practice Address - Phone:661-942-7313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34906152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist