Provider Demographics
NPI:1316255508
Name:PETROSYAN, MARIANNA TOVMASYAN (OD)
Entity type:Individual
Prefix:DR
First Name:MARIANNA
Middle Name:TOVMASYAN
Last Name:PETROSYAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 GLENOAKS BLVD.
Mailing Address - Street 2:
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-1436
Mailing Address - Country:US
Mailing Address - Phone:818-281-6148
Mailing Address - Fax:818-925-2212
Practice Address - Street 1:1011 GLENOAKS BLVD.
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-1436
Practice Address - Country:US
Practice Address - Phone:818-925-2225
Practice Address - Fax:818-925-2212
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14076152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist