Provider Demographics
NPI:1568766947
Name:MEHRABYAN, ELDA (OD)
Entity Type:Individual
Prefix:DR
First Name:ELDA
Middle Name:
Last Name:MEHRABYAN
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 1:155 CORDOVA ST
Mailing Address - Street 2:SUITE 168
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2727
Mailing Address - Country:US
Mailing Address - Phone:626-677-8881
Mailing Address - Fax:626-577-8878
Practice Address - Street 1:155 CORDOVA ST
Practice Address - Street 2:SUITE 168
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2727
Practice Address - Country:US
Practice Address - Phone:626-677-8881
Practice Address - Fax:626-577-8878
Is Sole Proprietor?:No
Enumeration Date:2010-12-29
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14089152WC0802X, 152W00000X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEP461AMedicare PIN