Provider Demographics
NPI:1033768924
Name:DAVIDIAN, TALIN VIVIAN (OD)
Entity Type:Individual
Prefix:
First Name:TALIN
Middle Name:VIVIAN
Last Name:DAVIDIAN
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 1:3043 STEVENS ST
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-2728
Mailing Address - Country:US
Mailing Address - Phone:818-517-2761
Mailing Address - Fax:
Practice Address - Street 1:12920 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-4928
Practice Address - Country:US
Practice Address - Phone:747-999-3877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-04
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT34077152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist