Provider Demographics
NPI:1134253693
Name:TERZIAN, MICHAEL VAROUJAN (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:VAROUJAN
Last Name:TERZIAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11151 TAMPA AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91326-2254
Mailing Address - Country:US
Mailing Address - Phone:818-366-9664
Mailing Address - Fax:818-368-5314
Practice Address - Street 1:11151 TAMPA AVE
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91326-2254
Practice Address - Country:US
Practice Address - Phone:818-366-9664
Practice Address - Fax:818-368-5314
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12364T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0123640Medicaid
CAWOP12364AOtherMEDICARE MEMBER ID
CAWOP12364AOtherMEDICARE MEMBER ID
CAGP010ZMedicare PIN