Provider Demographics
NPI:1114011103
Name:ARJOMAND, VIDA L (OD)
Entity Type:Individual
Prefix:MS
First Name:VIDA
Middle Name:L
Last Name:ARJOMAND
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 1:330 N BRAND BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-2308
Mailing Address - Country:US
Mailing Address - Phone:818-240-0890
Mailing Address - Fax:818-246-2540
Practice Address - Street 1:2800 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-6607
Practice Address - Country:US
Practice Address - Phone:714-547-8129
Practice Address - Fax:714-547-5626
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10226T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU55931Medicare UPIN