Individual provider Active NPI

Talin Vivian Davidian, OD

  • Optometrist
  • Sylmar, CA
National Provider Identifier
1033768924
Registry record updated May 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT34077 Issued in CA
Practice address
12920 Foothill Blvd
Sylmar, CA 91342-4928
Phone
(747) 999-3879
NPI assigned
Sep 4, 2019
Last updated
May 30, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 30, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPT34077 CA Primary

Addresses

Primary practice location

12920 Foothill Blvd
Sylmar, CA 91342-4928

Mailing address

12920 Foothill Blvd
Sylmar, CA 91342-4928
Phone (747) 999-3879

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201028001039 CA Practitioner - Optometry 4284044546 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
34077CAMDClinical Psychologist
OPT34077CAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Clinicas del Camino Real Inc CurrentSince Dec 1, 2020 Accepting new patients
Clinicas del Camino Real Inc CurrentSince Dec 1, 2020 Accepting new patients
Clinicas del Camino Real Inc Current Accepting new patients
Clinicas del Camino Real Inc PastSince Nov 1, 2020 Accepting new patients
Clinicas del Camino Real Inc PastSince Nov 1, 2020 Accepting new patients

Locations

500 E Main St
Santa Paula, CA 93060
Phone (805) 933-0895

200 S Wells Rd
Ventura, CA 93004
Phone (805) 647-6322

200 S Wells Rd
Ste 225
Ventura, CA 93004
Phone (805) 659-0560

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1567555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748563200000",
    "number": "1033768924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12920 FOOTHILL BLVD",
            "city": "SYLMAR",
            "state": "CA",
            "postal_code": "913424928",
            "telephone_number": "747-999-3879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12920 FOOTHILL BLVD",
            "city": "SYLMAR",
            "state": "CA",
            "postal_code": "913424928",
            "telephone_number": "747-999-3879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIDIAN",
        "first_name": "TALIN",
        "middle_name": "VIVIAN",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-04",
        "last_updated": "2025-05-30",
        "certification_date": "2025-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT34077",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sylmar, CA

Sources for this page

Verify at the official NPI Registry.