Healthcare Provider Details

I. General information

NPI: 1053239335
Provider Name (Legal Business Name): KHUNSHA ALTAF OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5321 S TELEGRAPH RD
DEARBORN HEIGHTS MI
48125-2031
US

IV. Provider business mailing address

5925 EVERGREEN RD APT 1
DEARBORN HEIGHTS MI
48127-2735
US

V. Phone/Fax

Practice location:
  • Phone: 313-292-7770
  • Fax:
Mailing address:
  • Phone: 312-483-9545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901005977
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: