Healthcare Provider Details

I. General information

NPI: 1316992571
Provider Name (Legal Business Name): ASMA S KHAN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 01/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3214 CHARLES B ROOT WYND STE 120
RALEIGH NC
27612-5440
US

IV. Provider business mailing address

1950 OLD GALLOWS RD STE 520
VIENNA VA
22182-3990
US

V. Phone/Fax

Practice location:
  • Phone: 919-881-0900
  • Fax: 919-881-0911
Mailing address:
  • Phone: 703-847-8899
  • Fax: 703-991-0514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1864
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number1864
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: