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General NPI Number Information
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NPI Number | 1497069256
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Entity Type | Individual
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Provider Name | MANDEEP BAINS O.D.
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Gender | Female
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Dates
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Enumeration Date | 08/03/2010
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Last Update Date | 08/04/2010
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Provider Practice Location Address
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Address Line | 8351 ANDERSON BLVD
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City | FORT WORTH
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State | TX
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Zip | 76120-3625
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Country | US
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Telephone | 817-277-1574
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Fax |
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Provider Business Mailing Address
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Address Line | 2929 WYCLIFF AVE APT. 2321
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City | DALLAS
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State | TX
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Zip | 75219-2646
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Country | US
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Telephone | 954-495-5563
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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 | 7630T
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License Number State | TX
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