Provider Demographics
NPI:1669584702
Name:KHROYAN, ANI HALABI (OD)
Entity type:Individual
Prefix:DR
First Name:ANI
Middle Name:HALABI
Last Name:KHROYAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ANI
Other - Middle Name:
Other - Last Name:HALABI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:413 E GLENOAKS BLVD
Mailing Address - Street 2:SUITE #B
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91207-2013
Mailing Address - Country:US
Mailing Address - Phone:818-230-0550
Mailing Address - Fax:818-244-8175
Practice Address - Street 1:413 E GLENOAKS BLVD
Practice Address - Street 2:SUITE #B
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91207-2013
Practice Address - Country:US
Practice Address - Phone:818-230-0550
Practice Address - Fax:818-244-8175
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12807 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEA 696ZOtherMEDICARE PTAN INDIVIDUAL
CAEZ690AOtherMEDICARE GROUP PTAN
CAWOP12807BMedicare PIN
CAEA690AMedicare PIN