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General NPI Number Information
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NPI Number | 1093488306
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Entity Type | Individual
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Provider Name | MANDEEP BANWAIT OD
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Gender | Male
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Dates
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Enumeration Date | 08/01/2021
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Last Update Date | 08/01/2021
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Provider Practice Location Address
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Address Line | 5301 ALMADEN EXPY
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City | SAN JOSE
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State | CA
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Zip | 95118-3603
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Country | US
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Telephone | 408-960-1014
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Fax |
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Provider Business Mailing Address
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Address Line | 2845 NORCREST DR
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City | SAN JOSE
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State | CA
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Zip | 95148-2226
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Country | US
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Telephone | 408-476-7081
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 34871
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License Number State | CA
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