Provider Demographics
NPI:1346422383
Name:BAGDASARIAN, VLAD A
Entity Type:Individual
Prefix:
First Name:VLAD
Middle Name:A
Last Name:BAGDASARIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-2101
Mailing Address - Country:US
Mailing Address - Phone:215-742-5333
Mailing Address - Fax:215-742-5334
Practice Address - Street 1:501 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19120-2101
Practice Address - Country:US
Practice Address - Phone:215-742-5333
Practice Address - Fax:215-742-5334
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-01
Last Update Date:2008-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008122156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician