MEDICARE: DR. JILBER FOULADIAN O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	12294T	CA

General Provider Information

NPI Number	:	1174669873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JILBER FOULADIAN O.D.

Provider Business Mailing Address
First Line	:	1312 WESTWOOD BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-4902
Country	:	US
Telephone Number	:	310-709-4373
Fax Number	:	310-388-0188

Provider Business Practice Location Address
First Line	:	1312 WESTWOOD BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-4902
Country	:	US
Telephone Number	:	310-234-8900
Fax Number	:	310-388-0188

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	06/22/2017

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