Provider Demographics
NPI:1376958140
Name:BAKHTARY, BAHAR
Entity Type:Individual
Prefix:
First Name:BAHAR
Middle Name:
Last Name:BAKHTARY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 DEL MONTE CTR
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-6130
Mailing Address - Country:US
Mailing Address - Phone:831-375-7755
Mailing Address - Fax:
Practice Address - Street 1:228 DEL MONTE CTR
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-6130
Practice Address - Country:US
Practice Address - Phone:831-375-7755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15023152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist