Provider Demographics
NPI:1720423890
Name:HRIPSIME SHIRVANIAN, O.D., OPTOMETRY, INC.
Entity type:Organization
Organization Name:HRIPSIME SHIRVANIAN, O.D., OPTOMETRY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HRIPSIME
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIRVANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:626-460-6022
Mailing Address - Street 1:1024 MISSION ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-3164
Mailing Address - Country:US
Mailing Address - Phone:626-460-6022
Mailing Address - Fax:626-460-6024
Practice Address - Street 1:1024 MISSION ST
Practice Address - Street 2:SUITE B
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-3164
Practice Address - Country:US
Practice Address - Phone:626-460-6022
Practice Address - Fax:626-460-6024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-02
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13564152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAZ190NMedicare PIN