Provider Demographics
NPI:1962567677
Name:FELESTIAN, CAROL (OD)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:FELESTIAN
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 1:2625 W ALAMEDA AVE
Mailing Address - Street 2:208
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4806
Mailing Address - Country:US
Mailing Address - Phone:818-845-3557
Mailing Address - Fax:
Practice Address - Street 1:2625 W ALAMEDA AVE
Practice Address - Street 2:208
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4806
Practice Address - Country:US
Practice Address - Phone:818-845-3557
Practice Address - Fax:818-845-2600
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13011152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist