Provider Demographics
NPI:1821152273
Name:GRETA TOROSSIAN, OPTOMETRIC CORP.
Entity Type:Organization
Organization Name:GRETA TOROSSIAN, OPTOMETRIC CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GRETA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOROSSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:818-956-3728
Mailing Address - Street 1:330 N BRAND BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-2308
Mailing Address - Country:US
Mailing Address - Phone:818-956-3728
Mailing Address - Fax:
Practice Address - Street 1:330 N BRAND BLVD STE 110
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-2308
Practice Address - Country:US
Practice Address - Phone:818-956-3728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOP11552T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOP11552BOtherMEDICARE PPIN
CAGY159AMedicare PIN
CAWOP11552BOtherMEDICARE PPIN
CAW20654Medicare PIN