Healthcare Provider Details

I. General information

NPI: 1982885273
Provider Name (Legal Business Name): HAMLET MINASVAND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 09/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 N VERDUGO RD SUITE A
GLENDALE CA
91206-3944
US

IV. Provider business mailing address

5181 HOLLYWOOD BLVD
LOS ANGELES CA
90027-6113
US

V. Phone/Fax

Practice location:
  • Phone: 323-882-8246
  • Fax:
Mailing address:
  • Phone: 323-662-9629
  • Fax: 323-662-0915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number11567
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: