Provider Demographics
NPI:1518089663
Name:CAROL AIVAZIAN OPT D PROFESSIONAL CORP
Entity Type:Organization
Organization Name:CAROL AIVAZIAN OPT D PROFESSIONAL CORP
Other - Org Name:TWENTY TWENTY OPTOMETRIC EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:AIVAZIAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:661-287-3939
Mailing Address - Street 1:23300 CINEMA DR STE 210
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-1776
Mailing Address - Country:US
Mailing Address - Phone:661-287-3939
Mailing Address - Fax:
Practice Address - Street 1:23300 CINEMA DR STE 210
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-1776
Practice Address - Country:US
Practice Address - Phone:661-287-3939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11039T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW21937OtherMEDICARE PTAN