Healthcare Provider Details

I. General information

NPI: 1629803168
Provider Name (Legal Business Name): BRAND OPTOMETRY A PROF CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 N BRAND BLVD STE 110
GLENDALE CA
91203-2308
US

IV. Provider business mailing address

330 N BRAND BLVD STE 110
GLENDALE CA
91203-2308
US

V. Phone/Fax

Practice location:
  • Phone: 818-241-4921
  • Fax: 818-241-0468
Mailing address:
  • Phone: 818-241-4921
  • Fax: 818-241-0468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State

VIII. Authorized Official

Name: YOUSEF KANGARANI
Title or Position: MANAGER
Credential:
Phone: 818-241-4921