Provider Demographics
NPI:1144828690
Name:BOGHOSSIAN VISION, A PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:BOGHOSSIAN VISION, A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGHOSSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:925-736-5959
Mailing Address - Street 1:3380 BLACKHAWK PLAZA CIR STE 200
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94506-4910
Mailing Address - Country:US
Mailing Address - Phone:925-736-5959
Mailing Address - Fax:925-886-5521
Practice Address - Street 1:3380 BLACKHAWK PLAZA CIR STE 200
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94506-4910
Practice Address - Country:US
Practice Address - Phone:925-736-5959
Practice Address - Fax:925-886-5521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty