Provider Demographics
NPI:1710021985
Name:CARL HAZARIAN
Entity Type:Organization
Organization Name:CARL HAZARIAN
Other - Org Name:LA LUNETTE OPTICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGISTERED OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAZARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-669-1053
Mailing Address - Street 1:2595 E WASHINGTON BLVD STE 105A
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-1409
Mailing Address - Country:US
Mailing Address - Phone:323-669-1053
Mailing Address - Fax:
Practice Address - Street 1:5101 SANTA MONICA BLVD STE 6
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-2480
Practice Address - Country:US
Practice Address - Phone:323-669-1053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD3128156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADX003128FMedicaid
CA0836040002Medicare NSC