Individual provider Active NPI

Nilam Bansal, O.D.

  • Optometrist
  • Waldorf, MD
National Provider Identifier
1396012969
Registry record updated Aug 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
33339 Issued in CA
Practice address
11930 Acton LN
Waldorf, MD 20601-3689
Phone
(520) 240-9317
NPI assigned
Nov 25, 2011
Last updated
Aug 22, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 22, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X TA2295 MD
Optometrist 152W00000X 33339 CA Primary

Addresses

Primary practice location

11930 Acton LN
Waldorf, MD 20601-3689

Mailing address

13905 Chadsworth Ter
Laurel, MD 20707-9436
Phone (520) 240-9317

Other practice location 1

1809 National Ave
San Diego, CA 92113-2113
Phone (619) 515-2300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160513001161 CA Practitioner - Optometry 4981847787 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
33339CAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Family Health Centers of San Diego, Inc CurrentSince Oct 16, 2022 Accepting new patients
Through the Hayes Optometry Inc Optometrist CurrentSince Jul 13, 2025 Accepting new patients
Family Health Centers of San Diego, Inc CurrentSince Oct 16, 2022 Accepting new patients
Dr Anup K Panjwani and Associates Inc Optometrist Past Accepting new patients

Locations

1809 National Ave
San Diego, CA 92113
Phone (619) 515-2500

823 Gateway Center Way
San Diego, CA 92102
Phone (619) 515-2323

130 S Sunnyvale Ave
Sunnyvale, CA 94086
Phone (408) 736-3802

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1322179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692662400000",
    "number": "1396012969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13905 CHADSWORTH TER",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207079436",
            "telephone_number": "520-240-9317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11930 ACTON LN",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206013689",
            "telephone_number": "520-240-9317"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1809 National Ave",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921132113",
            "country_code": "US",
            "telephone_number": "619-515-2300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BANSAL",
        "first_name": "NILAM",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-11-25",
        "last_updated": "2023-08-22",
        "certification_date": "2023-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MD",
            "license": "TA2295",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "33339",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waldorf, MD

Sources for this page

Verify at the official NPI Registry.