MEDICARE: DR B KAMKAR OD A PROFESSIONAL OPTOMETRY CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152WC0802X	Corneal and Contact Management Optometrist	OPT8512TLG	CA
2	152WL0500X	Low Vision Rehabilitation Optometrist	OPT8512TLG	CA
3	152WP0200X	Pediatric Optometrist	OPT8512TLG	CA
4	152WX0102X	Occupational Vision Optometrist	OPT8512TLG	CA
5	152W00000X	Optometrist	OPT8512TLG	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710190251
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR B KAMKAR OD A PROFESSIONAL OPTOMETRY CORP

Provider Business Mailing Address
First Line	:	1104 E COLORADO ST
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-1309
Country	:	US
Telephone Number	:	818-500-8008
Fax Number	:	818-500-8075

Provider Business Practice Location Address
First Line	:	1104 E COLORADO ST
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-1309
Country	:	US
Telephone Number	:	818-500-8008
Fax Number	:	818-500-8075

Authorized Official
Title or Position	:	CEO, OWNER, DOCTOR
Name	:	DR. BABAK KAMKAR
Credential	:	O.D., Q.M.E.
Telephone Number	:	818-500-8008

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	10/27/2021

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