Provider Demographics
NPI:1942982624
Name:WESTERN OPTOMETRIC CENTER INC
Entity Type:Organization
Organization Name:WESTERN OPTOMETRIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHALJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:818-913-0590
Mailing Address - Street 1:2146 LAS LUNAS ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-2420
Mailing Address - Country:US
Mailing Address - Phone:818-913-0590
Mailing Address - Fax:
Practice Address - Street 1:237 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-4107
Practice Address - Country:US
Practice Address - Phone:323-469-1929
Practice Address - Fax:323-672-8393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-02
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA35569OtherCA STATE BOARD OF OPTOMETRY