Provider Demographics
NPI:1497748206
Name:DOROUDIAN, ALETA (OD)
Entity Type:Individual
Prefix:
First Name:ALETA
Middle Name:
Last Name:DOROUDIAN
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:YUMA VISION CENTER
Mailing Address - Street 2:2750 S. PACIFIC AVE SUITE D
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365
Mailing Address - Country:US
Mailing Address - Phone:520-670-3909
Mailing Address - Fax:520-884-9287
Practice Address - Street 1:YUMA VISION CENTER
Practice Address - Street 2:2750 S. PACIFIC AVE. SUITE D
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365
Practice Address - Country:US
Practice Address - Phone:928-782-7557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2022-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ911152W00000X
AZOPT-000911152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ331439Medicaid
AZU58748Medicare UPIN
AZ331439Medicaid