Provider Demographics
NPI:1477652949
Name:GARIBYAN, MELANYA (OD)
Entity Type:Individual
Prefix:DR
First Name:MELANYA
Middle Name:
Last Name:GARIBYAN
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 1:2224 FLINTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-1021
Mailing Address - Country:US
Mailing Address - Phone:818-212-8666
Mailing Address - Fax:
Practice Address - Street 1:149 S GLENOAKS BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1315
Practice Address - Country:US
Practice Address - Phone:818-848-3000
Practice Address - Fax:818-848-7288
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12578T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOP12578Medicare PIN