Provider Demographics
NPI:1932736261
Name:MANANIAN, SATO (OD, MBS)
Entity Type:Individual
Prefix:
First Name:SATO
Middle Name:
Last Name:MANANIAN
Suffix:
Gender:F
Credentials:OD, MBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 RANGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-1148
Mailing Address - Country:US
Mailing Address - Phone:818-269-2685
Mailing Address - Fax:
Practice Address - Street 1:2700 E FOOTHILL BLVD STE 207
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-7111
Practice Address - Country:US
Practice Address - Phone:626-578-9685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34316-TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist