Healthcare Provider Details

I. General information

NPI: 1568646776
Provider Name (Legal Business Name): ALOK BANSAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2007
Last Update Date: 12/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2485 HOSPITAL DR SUITE 200
MOUNTAIN VIEW CA
94040-4101
US

IV. Provider business mailing address

2485 HOSPITAL DR STE 200
MOUNTAIN VIEW CA
94040-4123
US

V. Phone/Fax

Practice location:
  • Phone: 650-988-7480
  • Fax:
Mailing address:
  • Phone: 650-988-4197
  • Fax: 650-988-7482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberA120272
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA120272
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: