Provider Demographics
NPI:1316231764
Name:INGSTAD, ARIANA JAVANEH (OD)
Entity Type:Individual
Prefix:DR
First Name:ARIANA
Middle Name:JAVANEH
Last Name:INGSTAD
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 1:79795 CALIFORNIA 111
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-4756
Mailing Address - Country:US
Mailing Address - Phone:562-522-1139
Mailing Address - Fax:
Practice Address - Street 1:79795 HIGHWAY 111
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-4756
Practice Address - Country:US
Practice Address - Phone:562-522-1139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13936152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist