Provider Demographics
NPI:1952741662
Name:GRIGORIAN, ANI (DO)
Entity Type:Individual
Prefix:DR
First Name:ANI
Middle Name:
Last Name:GRIGORIAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14434 HAMLIN STREET
Mailing Address - Street 2:SUITE 1
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401
Mailing Address - Country:US
Mailing Address - Phone:818-785-4040
Mailing Address - Fax:818-785-4608
Practice Address - Street 1:14434 HAMLIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-1461
Practice Address - Country:US
Practice Address - Phone:818-785-4040
Practice Address - Fax:818-785-4608
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 14650 TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1780721944Medicare PIN