MEDICARE: VIVID SIGHT MD GROUP INC

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

General Provider Information

NPI Number	:	1518821636
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIVID SIGHT MD GROUP INC

Provider Business Mailing Address
First Line	:	10906 RIVERSIDE DR
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91602
Country	:	US
Telephone Number	:	818-330-3688
Fax Number	:	818-433-6388

Provider Business Practice Location Address
First Line	:	10906 RIVERSIDE DR
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91602
Country	:	US
Telephone Number	:	818-330-3688
Fax Number	:	818-433-6388

Authorized Official
Title or Position	:	CEO /OWNER
Name	:	HAMLET MINASVAND
Credential	:	OPTOMERTRY
Telephone Number	:	818-330-3688

Provider Enumeration Date	:	12/12/2025
Last Update Date	:	12/12/2025

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