Healthcare Provider Details

I. General information

NPI: 1831043173
Provider Name (Legal Business Name): SPECIALTY EYE CARE MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2026
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1146 N BRAND BLVD
GLENDALE CA
91202-2504
US

IV. Provider business mailing address

1146 N BRAND BLVD
GLENDALE CA
91202-2504
US

V. Phone/Fax

Practice location:
  • Phone: 818-265-7777
  • Fax:
Mailing address:
  • Phone: 818-265-7777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: NICOLE MIRZOYAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 626-696-0324