Provider Demographics
NPI:1235141144
Name:HAMLET MINASVAND PROF CORP
Entity Type:Organization
Organization Name:HAMLET MINASVAND PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAMLET
Authorized Official - Middle Name:
Authorized Official - Last Name:MINASVAND
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:818-439-2021
Mailing Address - Street 1:7188 W SUNSET BLVD
Mailing Address - Street 2:UNIT 200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-4400
Mailing Address - Country:US
Mailing Address - Phone:818-439-2021
Mailing Address - Fax:
Practice Address - Street 1:7188 W SUNSET BLVD
Practice Address - Street 2:UNIT 200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-4400
Practice Address - Country:US
Practice Address - Phone:818-439-2021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11567T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU85294Medicare UPIN