Provider Demographics
NPI:1588775043
Name:DALWADI, KAMINI (OD)
Entity type:Individual
Prefix:
First Name:KAMINI
Middle Name:
Last Name:DALWADI
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 1:6157 SATTERFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-6964
Mailing Address - Country:US
Mailing Address - Phone:312-316-1996
Mailing Address - Fax:
Practice Address - Street 1:330 INLAND CTR
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-1956
Practice Address - Country:US
Practice Address - Phone:661-575-9090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13205152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA 13205 TPLOtherCALIFORNIA BOARD OF OPTOMETRY
MI4901004400OtherSTATE LICENSE