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General NPI Number Information
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NPI Number | 1386819514
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Entity Type | Individual
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Provider Name | MAHNAZ BANGASH
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Gender | Female
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Dates
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Enumeration Date | 04/29/2008
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Last Update Date | 12/24/2015
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Provider Practice Location Address
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Address Line | 474 RANDALL RD
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City | SOUTH ELGIN
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State | IL
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Zip | 60177-3317
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Country | US
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Telephone | 847-214-8076
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Fax |
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Provider Business Mailing Address
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Address Line | 33 OLYMPIC DR
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City | SOUTH BARRINGTON
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State | IL
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Zip | 60010-1093
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Country | US
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Telephone | 847-951-9698
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046010845
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License Number State | IL
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