Healthcare Provider Details

I. General information

NPI: 1669584702
Provider Name (Legal Business Name): ANI HALABI KHROYAN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANI HALABI O.D.

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 04/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 E GLENOAKS BLVD SUITE #B
GLENDALE CA
91207-2013
US

IV. Provider business mailing address

413 E GLENOAKS BLVD SUITE #B
GLENDALE CA
91207-2013
US

V. Phone/Fax

Practice location:
  • Phone: 818-230-0550
  • Fax: 818-244-8175
Mailing address:
  • Phone: 818-230-0550
  • Fax: 818-244-8175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number12807 TPA
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: