Provider Demographics
NPI:1972651339
Name:RICHARD H HAVUNJIAN MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:RICHARD H HAVUNJIAN MD A PROFESSIONAL CORPORATION
Other - Org Name:EYE CARE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:HRATCHIA
Authorized Official - Last Name:HAVUNJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-548-5858
Mailing Address - Street 1:1510 S CENTRAL AVE STE 530
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-2542
Mailing Address - Country:US
Mailing Address - Phone:818-548-5858
Mailing Address - Fax:818-500-8355
Practice Address - Street 1:1510 S CENTRAL AVE STE 530
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2542
Practice Address - Country:US
Practice Address - Phone:818-548-5858
Practice Address - Fax:818-500-8355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0089220Medicaid
CAGR0089220Medicaid
CA4575620001Medicare NSC