Provider Demographics
NPI:1043039431
Name:OUZOUNIAN, LILLYT (OD)
Entity type:Individual
Prefix:
First Name:LILLYT
Middle Name:
Last Name:OUZOUNIAN
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 1:1101 GALLERIA WAY
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91210-1301
Mailing Address - Country:US
Mailing Address - Phone:818-552-4450
Mailing Address - Fax:
Practice Address - Street 1:1101 GALLERIA WAY
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91210-1301
Practice Address - Country:US
Practice Address - Phone:818-552-4450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-03
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35864152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist