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Tilganga Tour Plan Log
Visit Date: Working Days
Address: Bagmati Bridge, Gaushala, Kathmandu
Contact us at (+977) 9851061980 , (+977) 9849827211 , krishna.shrestha@tilganga.org , manita.pokharel@tilganga.org
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Preferred Time of Visit (Could Vary upon the condition)
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08:00 AM
04:00 PM
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Wednesday (11th June)
Thursday (12th June)
Friday (13th June)
Most Preferred Area of the Visit
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Outreach and Program Department
Nepal Eye Bank
Academics and Training Department
General OPD/OT Areas
The Fred Hollows Intraocular Lens Laboratory (FHIOL)
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Choose the best Category of Visit Plan for You
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Route 1: Entry from Block A (Riverside), Emergency Unit, Nepal Eye bank, Outreach & Program Department, FHIOL Lab
Route 2: Entry from Block B (New Building), General OPD Area, Pre/Post Operative Area, Subspecialty Clinic, Academic and Training Unit
Route 3: Entry from Block A (Riverside) then proceed to FHIOL Lab
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Preferred Duration of the Visit
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Half an Hour
1 Hour
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