MEDICARE: MICHAEL V. TERZIAN, O.D., A PROFESSIONAL CORPORATION

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	12364	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336496587
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL V. TERZIAN, O.D., A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	11151 TAMPA AVE
Second Line	:
City	:	NORTHRIDGE
State	:	CA
Zip	:	91326-2254
Country	:	US
Telephone Number	:	818-366-9664
Fax Number	:	818-368-5314

Provider Business Practice Location Address
First Line	:	11151 TAMPA AVE
Second Line	:
City	:	NORTHRIDGE
State	:	CA
Zip	:	91326-2254
Country	:	US
Telephone Number	:	818-366-9664
Fax Number	:	818-368-5314

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL VAROUJAN TERZIAN
Credential	:	O.D.
Telephone Number	:	818-366-9664

Provider Enumeration Date	:	08/07/2012
Last Update Date	:	06/10/2016

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