Provider Demographics
NPI:1336548932
Name:BOANDANG OPTOMETRY INC
Entity Type:Organization
Organization Name:BOANDANG OPTOMETRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-638-0852
Mailing Address - Street 1:8942 GARDEN GROVE BLVD
Mailing Address - Street 2:STE 104
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-3327
Mailing Address - Country:US
Mailing Address - Phone:714-638-0852
Mailing Address - Fax:
Practice Address - Street 1:8942 GARDEN GROVE BLVD
Practice Address - Street 2:STE 104
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-3327
Practice Address - Country:US
Practice Address - Phone:714-638-0852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14932152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty