Provider Demographics
NPI:1801892450
Name:KAMKAR, BABAK (OD, QME)
Entity type:Individual
Prefix:DR
First Name:BABAK
Middle Name:
Last Name:KAMKAR
Suffix:
Gender:M
Credentials:OD, QME
Other - Prefix:DR
Other - First Name:BOB
Other - Middle Name:
Other - Last Name:KAMKAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD, QME
Mailing Address - Street 1:1104 E COLORADO ST
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1309
Mailing Address - Country:US
Mailing Address - Phone:818-500-8008
Mailing Address - Fax:818-500-8075
Practice Address - Street 1:1104 E COLORADO ST
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1309
Practice Address - Country:US
Practice Address - Phone:818-500-8008
Practice Address - Fax:818-500-8075
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT8512T152WC0802X, 152WL0500X, 152WP0200X, 152WX0102X, 152W00000X
CA960487173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0085121Medicaid
CASD0085120Medicaid
CASD0085120Medicaid
CAOP8512AMedicare PIN