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NPI Code Detail

MEDICARE: DR. TATEVIK MANANIAN OD

MEDICARE: DR. TATEVIK MANANIAN OD
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
1152W00000XOptometrist34373TLGCA

General Provider Information

NPI Number : 1932757028
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TATEVIK MANANIAN OD
Provider Business Mailing Address
First Line : 201 E MAGNOLIA BLVD STE 261
Second Line :
City : BURBANK
State : CA
Zip : 91502-1162
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3200 N SEPULVEDA BLVD STE E4
Second Line :
City : MANHATTAN BEACH
State : CA
Zip : 90266-2469
Country : US
Telephone Number : 310-546-5568
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2019
Last Update Date : 08/31/2019

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Directions to “ DR. TATEVIK MANANIAN OD” Practice Location

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