Provider Demographics
NPI:1336539576
Name:BAINS, POONAM KAUR (OD)
Entity Type:Individual
Prefix:DR
First Name:POONAM
Middle Name:KAUR
Last Name:BAINS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 ABALONE PL
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-8606
Mailing Address - Country:US
Mailing Address - Phone:925-518-3356
Mailing Address - Fax:
Practice Address - Street 1:2565 SAND CREEK RD STE 124
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-7191
Practice Address - Country:US
Practice Address - Phone:925-240-8961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-26
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15162152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist