Provider Demographics
NPI:1205066750
Name:SULUKYAN, ANI BONIADI (OD)
Entity type:Individual
Prefix:DR
First Name:ANI
Middle Name:BONIADI
Last Name:SULUKYAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ANI
Other - Middle Name:
Other - Last Name:BONIADI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1139 ALAMEDA AVE
Mailing Address - Street 2:APT #5
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-1358
Mailing Address - Country:US
Mailing Address - Phone:818-563-9367
Mailing Address - Fax:
Practice Address - Street 1:9301 TAMPA AVE
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-2503
Practice Address - Country:US
Practice Address - Phone:818-885-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-17
Last Update Date:2021-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13764TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist