Healthcare Provider Details

I. General information

NPI: 1013821859
Provider Name (Legal Business Name): ANNA TER-GRIGORYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 PROMENADE WAY STE C
WESTLAKE VILLAGE CA
91362-3828
US

IV. Provider business mailing address

7818 BELLAIRE AVE
NORTH HOLLYWOOD CA
91605-2116
US

V. Phone/Fax

Practice location:
  • Phone: 805-222-7353
  • Fax:
Mailing address:
  • Phone: 818-808-5385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number36393
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: