Provider Demographics
NPI:1134345689
Name:KOUMJIAN, KAREN LYNNE (OD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:LYNNE
Last Name:KOUMJIAN
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 1:124 WATERTOWN ST
Mailing Address - Street 2:STE 3E
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-2500
Mailing Address - Country:US
Mailing Address - Phone:617-923-2761
Mailing Address - Fax:617-926-2835
Practice Address - Street 1:124 WATERTOWN ST
Practice Address - Street 2:STE 3E
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-2500
Practice Address - Country:US
Practice Address - Phone:617-923-2761
Practice Address - Fax:617-926-2835
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2921152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0342068Medicaid
MDW15548OtherBLUE CROSS BLUE SHIELD
MA718121OtherTUFTS
MA718121OtherTUFTS
MAT59310Medicare UPIN