Provider Demographics
NPI:1487474102
Name:BAJAJ DHAKAL OPTOMETRIC CORPORATION
Entity type:Organization
Organization Name:BAJAJ DHAKAL OPTOMETRIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUPARNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAJAJ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:562-355-0577
Mailing Address - Street 1:28212 FOXLANE DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91351-1201
Mailing Address - Country:US
Mailing Address - Phone:562-355-0577
Mailing Address - Fax:
Practice Address - Street 1:16522 SOLEDAD CANYON RD
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91387-3215
Practice Address - Country:US
Practice Address - Phone:661-567-0260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty