Healthcare Provider Details

I. General information

NPI: 1801892450
Provider Name (Legal Business Name): BABAK KAMKAR O.D., Q.M.E.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BOB KAMKAR O.D., Q.M.E.

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 10/27/2021
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 E COLORADO ST
GLENDALE CA
91205-1309
US

IV. Provider business mailing address

1104 E COLORADO ST
GLENDALE CA
91205-1309
US

V. Phone/Fax

Practice location:
  • Phone: 818-500-8008
  • Fax: 818-500-8075
Mailing address:
  • Phone: 818-500-8008
  • Fax: 818-500-8075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT8512T
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPT8512T
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberOPT8512T
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberOPT8512T
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License NumberOPT8512T
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number960487
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: