Provider Demographics
NPI:1093488306
Name:BANWAIT, MANDEEP (OD)
Entity Type:Individual
Prefix:DR
First Name:MANDEEP
Middle Name:
Last Name:BANWAIT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2845 NORCREST DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-2226
Mailing Address - Country:US
Mailing Address - Phone:408-476-7081
Mailing Address - Fax:
Practice Address - Street 1:5301 ALMADEN EXPY
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95118-3603
Practice Address - Country:US
Practice Address - Phone:408-960-1014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-01
Last Update Date:2021-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34871152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist