Active NPI
Kenneth B. Bandolik, OD
- Optometrist
- Riverhead, NY
National Provider Identifier
1467528547
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- T002927-1
- Practice address
- 755 Old Country Rd
Riverhead, NY 11901-2111 - Phone
- (631) 727-3173
- Fax
- (631) 727-9194
- NPI assigned
- Nov 28, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | T002927-1 | NY | Primary |
Addresses
Primary practice location
755 Old Country Rd
Riverhead, NY 11901-2111
Mailing address
755 Old Country Rd
Riverhead, NY 11901-2111
Phone (631) 727-3173
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| T002927-1 | Other | NY | LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| T002927-1 | NY | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164672000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1467528547",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "755 OLD COUNTRY RD",
"city": "RIVERHEAD",
"state": "NY",
"postal_code": "119012111",
"telephone_number": "631-727-3173",
"fax_number": "631-727-9194"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "755 OLD COUNTRY RD",
"city": "RIVERHEAD",
"state": "NY",
"postal_code": "119012111",
"telephone_number": "631-727-3173",
"fax_number": "631-727-9194"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BANDOLIK",
"first_name": "KENNETH",
"middle_name": "B.",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NY",
"license": "T002927-1",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "T002927-1",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Riverhead, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.