Provider Demographics
NPI:1831505775
Name:YESAYAN, LILIT (OD)
Entity type:Individual
Prefix:DR
First Name:LILIT
Middle Name:
Last Name:YESAYAN
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 1:1141 N BRAND BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-3647
Mailing Address - Country:US
Mailing Address - Phone:818-303-3316
Mailing Address - Fax:
Practice Address - Street 1:1141 N BRAND BLVD STE 201
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-3647
Practice Address - Country:US
Practice Address - Phone:818-303-3316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-10
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
237700000X
CA14928152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist