Provider Demographics
NPI:1497069256
Name:BAINS, MANDEEP (OD)
Entity Type:Individual
Prefix:DR
First Name:MANDEEP
Middle Name:
Last Name:BAINS
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 1:2929 WYCLIFF AVE
Mailing Address - Street 2:APT. 2321
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-2646
Mailing Address - Country:US
Mailing Address - Phone:954-495-5563
Mailing Address - Fax:
Practice Address - Street 1:8351 ANDERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76120-3625
Practice Address - Country:US
Practice Address - Phone:817-277-1574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7630T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist