Provider Demographics
NPI:1992032411
Name:AMBARIAN, ANAIT S (OD)
Entity type:Individual
Prefix:
First Name:ANAIT
Middle Name:S
Last Name:AMBARIAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2100 WEBSTER ST
Mailing Address - Street 2:STE 214
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2375
Mailing Address - Country:US
Mailing Address - Phone:415-923-3007
Mailing Address - Fax:415-923-6586
Practice Address - Street 1:2100 WEBSTER ST
Practice Address - Street 2:STE 214
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2375
Practice Address - Country:US
Practice Address - Phone:415-923-3007
Practice Address - Fax:415-923-6586
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 13457152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist