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General NPI Number Information
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NPI Number | 1083145957
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Entity Type | Organization
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Legal Business Name | CAROL AIVAZIAN O D OPTOMETRIC CORPORATION
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Dates
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Enumeration Date | 03/23/2017
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Last Update Date | 11/06/2023
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Provider Practice Location Address
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Address Line | 9911 TOPANGA CANYON BLVD
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City | CHATSWORTH
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State | CA
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Zip | 91311-3602
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Country | US
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Telephone | 818-517-4644
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Fax | 661-287-3838
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Provider Business Mailing Address
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Address Line | 9911 TOPANGA CANYON BLVD
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City | CHATSWORTH
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State | CA
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Zip | 91311-3602
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Country | US
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Telephone | 818-517-4644
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Fax | 661-287-3838
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Authorized Official
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Title or Position | OWNER
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Name | DR. CAROL AIVAZIAN
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Credential | O.D.
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Telephone | 818-517-4644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT11039T
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License Number State | CA
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