MEDICARE: TALIN VIVIAN DAVIDIAN OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPT34077	CA

General Provider Information

NPI Number	:	1033768924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TALIN VIVIAN DAVIDIAN OD

Provider Business Mailing Address
First Line	:	12920 FOOTHILL BLVD
Second Line	:
City	:	SYLMAR
State	:	CA
Zip	:	91342-4928
Country	:	US
Telephone Number	:	747-999-3879
Fax Number	:

Provider Business Practice Location Address
First Line	:	12920 FOOTHILL BLVD
Second Line	:
City	:	SYLMAR
State	:	CA
Zip	:	91342-4928
Country	:	US
Telephone Number	:	747-999-3879
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2019
Last Update Date	:	05/30/2025

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