Provider Demographics
NPI:1396012969
Name:BANSAL, NILAM (OD)
Entity Type:Individual
Prefix:DR
First Name:NILAM
Middle Name:
Last Name:BANSAL
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 1:13905 CHADSWORTH TER
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-9436
Mailing Address - Country:US
Mailing Address - Phone:520-240-9317
Mailing Address - Fax:
Practice Address - Street 1:11930 ACTON LN
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-3689
Practice Address - Country:US
Practice Address - Phone:520-240-9317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-25
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2295152W00000X
CA33339152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist