Provider Demographics
NPI:1952750309
Name:BANDALI, KIRAN (OD)
Entity Type:Individual
Prefix:DR
First Name:KIRAN
Middle Name:
Last Name:BANDALI
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 1:1416 CEDAR GROVE PLANTATION DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-2522
Mailing Address - Country:US
Mailing Address - Phone:912-398-6252
Mailing Address - Fax:
Practice Address - Street 1:3535 ROSWELL RD
Practice Address - Street 2:STE 8
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-8826
Practice Address - Country:US
Practice Address - Phone:912-398-6252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002937152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist