MEDICARE: BANDAR BAWAZIR

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	152W00000X	Optometrist	Y5041829	CA

General Provider Information

NPI Number	:	1770400301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BANDAR BAWAZIR

Provider Business Mailing Address
First Line	:	810 GONZALEZ DR APT 5D
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94132-2223
Country	:	US
Telephone Number	:	917-932-5753
Fax Number	:

Provider Business Practice Location Address
First Line	:	810 GONZALEZ DR APT 5D
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94132-2223
Country	:	US
Telephone Number	:	917-932-5753
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2026
Last Update Date	:	07/03/2026

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Directions to “ BANDAR BAWAZIR ” Practice Location

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