Provider Demographics
NPI:1861414807
Name:TOROSSIAN, GRETA (OD)
Entity type:Individual
Prefix:
First Name:GRETA
Middle Name:
Last Name:TOROSSIAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:GRETA
Other - Middle Name:
Other - Last Name:TOROUSSIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:3522 MEVEL PL
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-1142
Mailing Address - Country:US
Mailing Address - Phone:818-319-2603
Mailing Address - Fax:
Practice Address - Street 1:330 N BRAND BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-2308
Practice Address - Country:US
Practice Address - Phone:818-956-3728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11552T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOP11552BOtherMEDICARE PPIN
CASD0015520Medicaid
CASD0015520Medicaid
CAWOP11552BOtherMEDICARE PPIN
CAW20654Medicare PIN