Provider Demographics
NPI:1568646776
Name:BANSAL, ALOK (MD)
Entity Type:Individual
Prefix:DR
First Name:ALOK
Middle Name:
Last Name:BANSAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2485 HOSPITAL DR
Mailing Address - Street 2:STE 200
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4123
Mailing Address - Country:US
Mailing Address - Phone:650-988-4197
Mailing Address - Fax:650-988-7482
Practice Address - Street 1:2485 HOSPITAL DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4101
Practice Address - Country:US
Practice Address - Phone:650-988-7480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA120272207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABW452BMedicare PIN
CABW452AMedicare PIN
CA1568646776Medicare PIN
CABW452CMedicare PIN