Provider Demographics
NPI:1801537691
Name:MKRTCHYAN, SERINE (DOCTOR OF OPTOMETRY)
Entity type:Individual
Prefix:DR
First Name:SERINE
Middle Name:
Last Name:MKRTCHYAN
Suffix:
Gender:F
Credentials:DOCTOR OF OPTOMETRY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8556 GULLO AVE
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-4048
Mailing Address - Country:US
Mailing Address - Phone:818-573-4867
Mailing Address - Fax:
Practice Address - Street 1:10605 BALBOA BLVD STE 230
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-6344
Practice Address - Country:US
Practice Address - Phone:818-368-4114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35118152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist