Provider Demographics
NPI:1326615527
Name:PANCHAL, MAYA (OD)
Entity Type:Individual
Prefix:DR
First Name:MAYA
Middle Name:
Last Name:PANCHAL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 DOUGLAS CT
Mailing Address - Street 2:
Mailing Address - City:WEST DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08086-2013
Mailing Address - Country:US
Mailing Address - Phone:856-419-8150
Mailing Address - Fax:
Practice Address - Street 1:748 ROUTE 73 S STE C
Practice Address - Street 2:
Practice Address - City:EVESHAM
Practice Address - State:NJ
Practice Address - Zip Code:08053-4135
Practice Address - Country:US
Practice Address - Phone:856-596-5925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00705200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist