Provider Demographics
NPI:1023164274
Name:AVAKIAN, LEVON (RDO)
Entity type:Individual
Prefix:MR
First Name:LEVON
Middle Name:
Last Name:AVAKIAN
Suffix:
Gender:M
Credentials:RDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17839 CHATSWORTH ST
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-5612
Mailing Address - Country:US
Mailing Address - Phone:818-488-1764
Mailing Address - Fax:818-488-1691
Practice Address - Street 1:17839 CHATSWORTH ST
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-5612
Practice Address - Country:US
Practice Address - Phone:818-488-1764
Practice Address - Fax:818-488-1691
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD 6425156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician