Provider Demographics
NPI:1265169791
Name:BULATHSINHALA, NILUPUL (OD)
Entity type:Individual
Prefix:
First Name:NILUPUL
Middle Name:
Last Name:BULATHSINHALA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14623 TIMBER CLIFF LN
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-1748
Mailing Address - Country:US
Mailing Address - Phone:832-642-1708
Mailing Address - Fax:
Practice Address - Street 1:14623 TIMBER CLIFF LN
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-1748
Practice Address - Country:US
Practice Address - Phone:832-642-1708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1955-901AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty