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General NPI Number Information
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NPI Number | 1396012969
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Entity Type | Individual
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Provider Name | NILAM BANSAL O.D.
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Gender | Female
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Dates
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Enumeration Date | 11/25/2011
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Last Update Date | 08/22/2023
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Provider Practice Location Address
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Address Line | 11930 ACTON LN
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City | WALDORF
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State | MD
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Zip | 20601-3689
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Country | US
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Telephone | 520-240-9317
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Fax |
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Provider Business Mailing Address
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Address Line | 13905 CHADSWORTH TER
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City | LAUREL
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State | MD
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Zip | 20707-9436
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Country | US
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Telephone | 520-240-9317
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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 | TA2295
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 33339
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License Number State | CA
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