Healthcare Provider Details

I. General information

NPI: 1265463145
Provider Name (Legal Business Name): ARLENE TANIA YEPREMIAN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 08/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

839 N GLENDALE AVE
GLENDALE CA
91206-2128
US

IV. Provider business mailing address

839 N GLENDALE AVE
GLENDALE CA
91206-2128
US

V. Phone/Fax

Practice location:
  • Phone: 818-240-3937
  • Fax: 818-240-3933
Mailing address:
  • Phone: 818-240-3937
  • Fax: 818-240-3933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number12022T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: