Healthcare Provider Details

I. General information

NPI: 1457299737
Provider Name (Legal Business Name): HARIS MIRZA OD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11133 BALBOA BLVD
GRANADA HILLS CA
91344-4204
US

IV. Provider business mailing address

11145 VANALDEN AVE
PORTER RANCH CA
91326-2346
US

V. Phone/Fax

Practice location:
  • Phone: 818-282-9110
  • Fax:
Mailing address:
  • Phone: 818-282-9110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: HARIS MIRZA
Title or Position: OPTOMETRIST/OWNER
Credential: OD
Phone: 818-282-9110