Provider Demographics
NPI:1790836955
Name:BANSIL, KAVITA (OD)
Entity Type:Individual
Prefix:DR
First Name:KAVITA
Middle Name:
Last Name:BANSIL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KAVITA
Other - Middle Name:BANSIL
Other - Last Name:CONVERSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:10452 SILVERDALE WAY NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-9411
Mailing Address - Country:US
Mailing Address - Phone:360-307-7300
Mailing Address - Fax:
Practice Address - Street 1:10452 SILVERDALE WAY NW
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-9411
Practice Address - Country:US
Practice Address - Phone:360-307-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00003138152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1334BAOtherBLUE SHIELD #
WA2020964Medicaid
WAUS2335669OtherAETNA SPECIALIST PIN
AKOD533WAMedicaid
WA0039597OtherLABOR AND INDUSTRIES #
WAUS2335669OtherAETNA SPECIALIST PIN
AKOD533WAMedicaid
WAAB17735Medicare PIN
WA1334BAOtherBLUE SHIELD #