MEDICARE: CARL HAZARIAN

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	156FX1800X	Optician	D3128	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	:	1710021985
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARL HAZARIAN

Provider Business Mailing Address
First Line	:	2595 E WASHINGTON BLVD STE 105A
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-1409
Country	:	US
Telephone Number	:	323-669-1053
Fax Number	:

Provider Business Practice Location Address
First Line	:	5101 SANTA MONICA BLVD STE 6
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-2480
Country	:	US
Telephone Number	:	323-669-1053
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED OPTICIAN
Name	:	CARL HAZARIAN
Credential	:
Telephone Number	:	323-669-1053

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	05/17/2011

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