Healthcare Provider Details

I. General information

NPI: 1891187548
Provider Name (Legal Business Name): AYESHA BUKHARI-KHAN O.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2015
Last Update Date: 03/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 E HALLANDALE BEACH BLVD
HALLANDALE BEACH FL
33009-4708
US

IV. Provider business mailing address

20007 NW 85TH AVE
HIALEAH FL
33015-5984
US

V. Phone/Fax

Practice location:
  • Phone: 954-458-2112
  • Fax:
Mailing address:
  • Phone: 786-281-2532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC5018
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: