Healthcare Provider Details

I. General information

NPI: 1104239144
Provider Name (Legal Business Name): NANAR HOVASAPIAN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2014
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1808 VERDUGO BLVD STE 103
GLENDALE CA
91208-1482
US

IV. Provider business mailing address

PO BOX 5861
GLENDALE CA
91221-5861
US

V. Phone/Fax

Practice location:
  • Phone: 310-906-0393
  • Fax:
Mailing address:
  • Phone: 310-906-0393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number14958
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: