Individual
DR. KENNETH B. BANDOLIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
755 OLD COUNTRY RD, RIVERHEAD, NY 11901-2111
(631) 727-3173
(631) 727-9194
Mailing address
755 OLD COUNTRY RD, RIVERHEAD, NY 11901-2111
(631) 727-3173
(631) 727-9194
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
T002927-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
T002927-1
LICENSE
NY
Enumeration date
11/28/2006
Last updated
07/08/2007
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