=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710021985
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARL HAZARIAN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2007
-----------------------------------------------------
Last Update Date | 05/17/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5101 SANTA MONICA BLVD STE 6
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90029-2480
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-669-1053
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2595 E WASHINGTON BLVD STE 105A
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91107-1409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-669-1053
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | REGISTERED OPTICIAN
-----------------------------------------------------
Name | CARL HAZARIAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 323-669-1053
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 156FX1800X
-----------------------------------------------------
Taxonomy Name | Optician
-----------------------------------------------------
License Number | D3128
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------