Provider Demographics
NPI:1225443062
Name:BHALANI, HAVISH RAMNIKLAL (OD)
Entity Type:Individual
Prefix:
First Name:HAVISH
Middle Name:RAMNIKLAL
Last Name:BHALANI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 COUNTRY CT
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-8812
Mailing Address - Country:US
Mailing Address - Phone:540-846-2202
Mailing Address - Fax:
Practice Address - Street 1:1871 CARL D SILVER PKWY
Practice Address - Street 2:UNIT 1113
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4969
Practice Address - Country:US
Practice Address - Phone:540-786-8081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002347152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist