Provider Demographics
NPI:1770807745
Name:ZAREH SIMONIAN OD INC , A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ZAREH SIMONIAN OD INC , A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ZAREH
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMONIAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:310-407-5440
Mailing Address - Street 1:232 S BRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-1310
Mailing Address - Country:US
Mailing Address - Phone:310-407-5440
Mailing Address - Fax:310-407-5441
Practice Address - Street 1:232 S BRAND BLVD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-1310
Practice Address - Country:US
Practice Address - Phone:310-407-5440
Practice Address - Fax:310-407-5441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-19
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT12490152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT12490OtherCA LICENCE