Provider Demographics
NPI:1447039052
Name:MELIKIAN, CAROLINE
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:MELIKIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6411 SEPULVEDA BLVD STE 1J
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-1304
Mailing Address - Country:US
Mailing Address - Phone:818-387-6075
Mailing Address - Fax:
Practice Address - Street 1:6411 SEPULVEDA BLVD STE 1J
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-1304
Practice Address - Country:US
Practice Address - Phone:818-387-6075
Practice Address - Fax:818-849-6821
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-22
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician