Provider Demographics
NPI:1780917070
Name:PANDYA, AALOK PANKAJRAY (OD)
Entity type:Individual
Prefix:DR
First Name:AALOK
Middle Name:PANKAJRAY
Last Name:PANDYA
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 1:1592 MITCHELL AVE
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-5825
Mailing Address - Country:US
Mailing Address - Phone:714-505-1590
Mailing Address - Fax:
Practice Address - Street 1:2063 BREA MALL
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-5756
Practice Address - Country:US
Practice Address - Phone:714-674-5040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 13842 TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist