Provider Demographics
NPI:1356426266
Name:BARSOUMIAN, JEAN (ABO)
Entity type:Individual
Prefix:MR
First Name:JEAN
Middle Name:
Last Name:BARSOUMIAN
Suffix:
Gender:M
Credentials:ABO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12073 DUNBLANE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91326-1133
Mailing Address - Country:US
Mailing Address - Phone:323-662-4785
Mailing Address - Fax:323-662-4787
Practice Address - Street 1:1300 N VERMONT AVE
Practice Address - Street 2:STE 103
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6005
Practice Address - Country:US
Practice Address - Phone:323-662-4785
Practice Address - Fax:323-662-4787
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3272156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician