Provider Demographics
NPI:1538983168
Name:YOUNAN, ELISYA (OD)
Entity type:Individual
Prefix:
First Name:ELISYA
Middle Name:
Last Name:YOUNAN
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 1:21900 BURBANK BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-7420
Mailing Address - Country:US
Mailing Address - Phone:909-725-5308
Mailing Address - Fax:
Practice Address - Street 1:751 E DAILY DR STE 110
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-6077
Practice Address - Country:US
Practice Address - Phone:805-987-8705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-11
Last Update Date:2024-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35868152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist