Provider Demographics
NPI:1689342818
Name:MARIANNA PETROSYAN O.D. AN OPTOMETRIC CORPORATION
Entity Type:Organization
Organization Name:MARIANNA PETROSYAN O.D. AN OPTOMETRIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETROSYAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:818-281-6148
Mailing Address - Street 1:380 GLEN SUMMER RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-1423
Mailing Address - Country:US
Mailing Address - Phone:818-281-6148
Mailing Address - Fax:
Practice Address - Street 1:1009 GLENOAKS BLVD
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-1436
Practice Address - Country:US
Practice Address - Phone:818-281-6148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty