Provider Demographics
NPI:1508505835
Name:HOVHANNISYAN, HOVHANNES (OD)
Entity Type:Individual
Prefix:DR
First Name:HOVHANNES
Middle Name:
Last Name:HOVHANNISYAN
Suffix:
Gender:M
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:PO BOX 58125
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CA
Mailing Address - Zip Code:90058-0125
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4501 S ALAMEDA ST STE G-29
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CA
Practice Address - Zip Code:90058-2010
Practice Address - Country:US
Practice Address - Phone:323-231-0005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-03
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35374152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management