Provider Demographics
NPI:1366794638
Name:RAMPHAL, MOHINDRA (OD)
Entity type:Individual
Prefix:MR
First Name:MOHINDRA
Middle Name:
Last Name:RAMPHAL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:MOHINDER
Other - Middle Name:
Other - Last Name:RAMPHAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:12504 GREENHILL DRIVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904
Mailing Address - Country:US
Mailing Address - Phone:301-602-1016
Mailing Address - Fax:
Practice Address - Street 1:12504 GREENHILL DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2965
Practice Address - Country:US
Practice Address - Phone:301-602-1016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2326152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist