Provider Demographics
NPI:1043547482
Name:DR. ARLENE T. YEPREMIAN, O.D. A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DR. ARLENE T. YEPREMIAN, O.D. A PROFESSIONAL CORPORATION
Other - Org Name:JEWEL CITY OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ARLENE
Authorized Official - Middle Name:TANIA
Authorized Official - Last Name:YEPREMIAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:818-240-3937
Mailing Address - Street 1:839 N GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-2128
Mailing Address - Country:US
Mailing Address - Phone:818-240-3937
Mailing Address - Fax:818-240-3933
Practice Address - Street 1:839 N GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-2128
Practice Address - Country:US
Practice Address - Phone:818-240-3937
Practice Address - Fax:818-240-3933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-05
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12022T152W00000X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1043547482Medicaid
CAEB359AMedicare PIN
CAEB360ZMedicare PIN