Healthcare Provider Details

I. General information

NPI: 1770807745
Provider Name (Legal Business Name): ZAREH SIMONIAN OD INC , A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2010
Last Update Date: 03/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 S BRAND BLVD
GLENDALE CA
91204-1310
US

IV. Provider business mailing address

232 S BRAND BLVD
GLENDALE CA
91204-1310
US

V. Phone/Fax

Practice location:
  • Phone: 310-407-5440
  • Fax: 310-407-5441
Mailing address:
  • Phone: 310-407-5440
  • Fax: 310-407-5441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT12490
License Number StateCA

VIII. Authorized Official

Name: ZAREH SIMONIAN
Title or Position: PRESIDENT
Credential: OD
Phone: 310-407-5440