=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760070858
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANAHIT SAHAKYAN OD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2021
-----------------------------------------------------
Last Update Date | 01/05/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 330 N BRAND BLVD STE 110
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91203-2308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-241-4921
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10154 FERNGLEN AVE APT 5
-----------------------------------------------------
City | TUJUNGA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91042-4011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-441-6186
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 34746
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------