Boris Mardian, OD.

Primary specialty

OptometristTaxonomy code 152W00000X

License

11702 Issued in CA

Practice address

113 E Broadway
Glendale, CA 91205-1006

Phone

(818) 241-7719

Fax

(818) 241-0507

NPI assigned

Jul 14, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Southern College of Optometry, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: boris.mardian@uprisedirect.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Broadway Family Optometry

  • Optometrist
  • Glendale, CA
  • NPI 1265101158
  Medicare reassignment NPD Authorized official
• Providence Facey Medical Foundation

  • Ambulatory Surgical Clinic/Center
  • Mission Hills, CA
  • NPI 1194083824
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595289600000",
    "number": "1477579506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 E BROADWAY",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912051006",
            "telephone_number": "818-241-7719",
            "fax_number": "818-241-0507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 E BROADWAY",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912051006",
            "telephone_number": "818-241-7719",
            "fax_number": "818-241-0507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARDIAN",
        "first_name": "BORIS",
        "name_prefix": "Dr.",
        "credential": "OD.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-14",
        "last_updated": "2020-07-21",
        "certification_date": "2020-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "11702",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00117020",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marco Gomez Garcia MD Inc
• Aleen Marcoosi
• Catherine Marcos
• Claire Elizabeth Marcoulier, RD
• Mardi H. Mihranian
• Gina Mardian, MFT
• Cristina Noelle Mardirossian
• Tina Mardirossian, MSW
• Margaret Sy DMD, a Professional Corporation
• Margarita Kazarian

• Optometrist in Glendale, CA
• Providers in Glendale, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.