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General NPI Number Information
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NPI Number | 1205066750
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Entity Type | Individual
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Provider Name | ANI BONIADI SULUKYAN O.D.
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Gender | Female
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Dates
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Enumeration Date | 07/17/2009
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Last Update Date | 10/23/2021
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Provider Practice Location Address
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Address Line | 9301 TAMPA AVE
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City | NORTHRIDGE
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State | CA
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Zip | 91324-2503
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Country | US
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Telephone | 818-885-7300
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Fax |
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Provider Business Mailing Address
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Address Line | 1139 ALAMEDA AVE APT #5
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City | GLENDALE
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State | CA
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Zip | 91201-1358
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Country | US
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Telephone | 818-563-9367
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 13764TLG
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License Number State | CA
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