Provider Demographics
NPI:1497865810
Name:RANA, HETAL (OD)
Entity Type:Individual
Prefix:
First Name:HETAL
Middle Name:
Last Name:RANA
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 1:10801 HICKORY RIDGE RD
Mailing Address - Street 2:STE 200
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3871
Mailing Address - Country:US
Mailing Address - Phone:410-997-1800
Mailing Address - Fax:443-319-5915
Practice Address - Street 1:10801 HICKORY RIDGE RD
Practice Address - Street 2:STE 200
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3871
Practice Address - Country:US
Practice Address - Phone:410-997-1800
Practice Address - Fax:443-319-5915
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4281152W00000X
MD2038152W00000X
IL046009681152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046009681Medicaid
U91555Medicare UPIN
IL046009681Medicaid