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General NPI Number Information
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NPI Number | 1659867901
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Entity Type | Organization
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Legal Business Name | SHAKEH BAGDASSAR EYE TO EYE OPTOMETRY
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Dates
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Enumeration Date | 07/10/2018
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Last Update Date | 07/10/2018
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Provider Practice Location Address
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Address Line | 1101 N PACIFIC AVE STE 105
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City | GLENDALE
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State | CA
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Zip | 91202-4314
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Country | US
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Telephone | 818-243-1111
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Fax |
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Provider Business Mailing Address
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Address Line | 1101 N PACIFIC AVE STE 105
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City | GLENDALE
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State | CA
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Zip | 91202-4314
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Country | US
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Telephone | 818-243-1111
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Fax |
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Authorized Official
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Title or Position | OWNER/ OPTOMETRIST
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Name | DR. SHAKEH BAGDASSAR
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Credential | O.D.
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Telephone | 818-243-1111
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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 | 9792T
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License Number State | CA
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