Provider Demographics
NPI:1235805318
Name:BANDAK, DIANA (OD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:
Last Name:BANDAK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:DIANA
Other - Middle Name:BANDAK
Other - Last Name:KATTAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3816 WOODRUFF AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-2145
Mailing Address - Country:US
Mailing Address - Phone:909-912-2724
Mailing Address - Fax:
Practice Address - Street 1:2323 16TH ST STE 400
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3454
Practice Address - Country:US
Practice Address - Phone:800-898-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-19
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT34850-TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist