Provider Demographics
NPI:1982885273
Name:MINASVAND, HAMLET
Entity Type:Individual
Prefix:
First Name:HAMLET
Middle Name:
Last Name:MINASVAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5181 HOLLYWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6113
Mailing Address - Country:US
Mailing Address - Phone:323-662-9629
Mailing Address - Fax:323-662-0915
Practice Address - Street 1:311 N VERDUGO RD
Practice Address - Street 2:SUITE A
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-3944
Practice Address - Country:US
Practice Address - Phone:323-882-8246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11567152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist