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General NPI Number Information
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NPI Number | 1689342818
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Entity Type | Organization
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Legal Business Name | MARIANNA PETROSYAN O.D. AN OPTOMETRIC CORPORATION
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Dates
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Enumeration Date | 09/02/2021
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Last Update Date | 09/02/2021
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Provider Practice Location Address
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Address Line | 1009 GLENOAKS BLVD
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City | SAN FERNANDO
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State | CA
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Zip | 91340-1436
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Country | US
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Telephone | 818-281-6148
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Fax |
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Provider Business Mailing Address
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Address Line | 380 GLEN SUMMER RD
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City | PASADENA
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State | CA
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Zip | 91105-1423
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Country | US
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Telephone | 818-281-6148
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARIANNA PETROSYAN
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Credential | OD
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Telephone | 818-281-6148
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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 |
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License Number State |
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