Provider Demographics
NPI:1316830185
Name:GHAZARYAN, NANE
Entity type:Individual
Prefix:
First Name:NANE
Middle Name:
Last Name:GHAZARYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10440 PLAINVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:TUJUNGA
Mailing Address - State:CA
Mailing Address - Zip Code:91042-1716
Mailing Address - Country:US
Mailing Address - Phone:323-533-0756
Mailing Address - Fax:
Practice Address - Street 1:1901 BROADVIEW DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1201
Practice Address - Country:US
Practice Address - Phone:818-369-7787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-31
Last Update Date:2025-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35955152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist