Provider Demographics
NPI:1043284359
Name:D'JANBATIAN, MOVSES (OD)
Entity type:Individual
Prefix:DR
First Name:MOVSES
Middle Name:
Last Name:D'JANBATIAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 N BRAND BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-2308
Mailing Address - Country:US
Mailing Address - Phone:818-241-4921
Mailing Address - Fax:818-241-0468
Practice Address - Street 1:330 N BRAND BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-2308
Practice Address - Country:US
Practice Address - Phone:818-241-4921
Practice Address - Fax:818-241-0468
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA07776TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0077760Medicaid
CA0383080001Medicare NSC
CASD0077760Medicaid
CAT70224Medicare UPIN