Provider Demographics
NPI:1659465540
Name:MIKHAYLYANTS, MIKHAIL SERGEY (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:MIKHAIL
Middle Name:SERGEY
Last Name:MIKHAYLYANTS
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 VANALDEN AVE
Mailing Address - Street 2:UNIT # 104
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-4137
Mailing Address - Country:US
Mailing Address - Phone:818-341-8987
Mailing Address - Fax:
Practice Address - Street 1:14659 TITUS STREET
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-4940
Practice Address - Country:US
Practice Address - Phone:818-785-7070
Practice Address - Fax:818-785-7070
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD 6442156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician