Provider Demographics
NPI:1275784118
Name:SHIRVANIAN, HRIPSIME (OD)
Entity Type:Individual
Prefix:DR
First Name:HRIPSIME
Middle Name:
Last Name:SHIRVANIAN
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 1:1024 MISSION ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-3164
Mailing Address - Country:US
Mailing Address - Phone:626-460-6022
Mailing Address - Fax:626-460-6024
Practice Address - Street 1:1024 MISSION ST
Practice Address - Street 2:SUITE B
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-3164
Practice Address - Country:US
Practice Address - Phone:626-460-6022
Practice Address - Fax:626-460-6024
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13564152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAZ190NMedicare PIN