Provider Demographics
NPI:1942333596
Name:ALAHDADI-OVANESSIAN, ADRINA (OD)
Entity Type:Individual
Prefix:DR
First Name:ADRINA
Middle Name:
Last Name:ALAHDADI-OVANESSIAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4170 VERDUGO RD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-3821
Mailing Address - Country:US
Mailing Address - Phone:323-255-8093
Mailing Address - Fax:323-255-8095
Practice Address - Street 1:4170 VERDUGO RD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90065-3821
Practice Address - Country:US
Practice Address - Phone:323-255-8093
Practice Address - Fax:323-255-8095
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 12108 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA211484OtherEYE MED VISION
CA13192OtherMEDICAL EYE SERVICES
CA470848075OtherVISION SERVICE PLAN
CASD0121080Medicaid
CA43936OtherSPECTERA VISION
CA470848075OtherBLUE CROSS OF CALIFORNIA
CA43936OtherSPECTERA VISION
CAOP12108Medicare ID - Type Unspecified