Healthcare Provider Details

I. General information

NPI: 1790478139
Provider Name (Legal Business Name): HOVHANNES HOVHANNISYAN, OD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2023
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16970 SAN FERNANDO MISSION BLVD STE C3
GRANADA HILLS CA
91344-4262
US

IV. Provider business mailing address

8118 WILKINSON AVE
NORTH HOLLYWOOD CA
91605-1240
US

V. Phone/Fax

Practice location:
  • Phone: 818-360-7522
  • Fax:
Mailing address:
  • Phone: 818-397-3523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. HOVHANNES HOVHANNISYAN
Title or Position: OWNER
Credential: OD
Phone: 818-397-3523