Provider Demographics
NPI:1760881270
Name:LILIT YESAYAN OD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:LILIT YESAYAN OD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:LILIT
Authorized Official - Middle Name:
Authorized Official - Last Name:YESAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-303-3316
Mailing Address - Street 1:1141 N BRAND BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-3647
Mailing Address - Country:US
Mailing Address - Phone:818-303-3316
Mailing Address - Fax:
Practice Address - Street 1:1141 N BRAND BLVD STE 201
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-3647
Practice Address - Country:US
Practice Address - Phone:818-303-3316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-20
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14928152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty