Healthcare Provider Details

I. General information

NPI: 1568766947
Provider Name (Legal Business Name): ELDA MEHRABYAN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2010
Last Update Date: 11/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 CORDOVA ST SUITE 168
PASADENA CA
91105-2727
US

IV. Provider business mailing address

155 CORDOVA ST SUITE 168
PASADENA CA
91105-2727
US

V. Phone/Fax

Practice location:
  • Phone: 626-677-8881
  • Fax: 626-577-8878
Mailing address:
  • Phone: 626-677-8881
  • Fax: 626-577-8878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number14089
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number14089
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number14089
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: