Healthcare Provider Details

I. General information

NPI: 1831025097
Provider Name (Legal Business Name): ATIF KHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6778 RIDGE AVE FL 1
PHILADELPHIA PA
19128-2487
US

IV. Provider business mailing address

8614 WESTWOOD CENTER DR FL 9
VIENNA VA
22182-2442
US

V. Phone/Fax

Practice location:
  • Phone: 215-483-1636
  • Fax: 215-443-8580
Mailing address:
  • Phone: 703-847-8899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG004383
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: