Basic Information
| Provider Information | |||||||||
| NPI: | 1497748206 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOROUDIAN | ||||||||
| FirstName: | ALETA | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | YUMA VISION CENTER | ||||||||
| Address2: | 2750 S. PACIFIC AVE SUITE D | ||||||||
| City: | YUMA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206703909 | ||||||||
| FaxNumber: | 5208849287 | ||||||||
| Practice Location | |||||||||
| Address1: | YUMA VISION CENTER | ||||||||
| Address2: | 2750 S. PACIFIC AVE. SUITE D | ||||||||
| City: | YUMA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287827557 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2005 | ||||||||
| LastUpdateDate: | 03/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 911 | AZ | N | Eye and Vision Services Providers | Optometrist | 152W00000X | OPT-000911 | AZ | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 331439 | 05 | AZ | MEDICAID |