Healthcare Provider Details

I. General information

NPI: 1952195067
Provider Name (Legal Business Name): ANSA KHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3405 MIDWAY RD STE 421
PLANO TX
75093-8144
US

IV. Provider business mailing address

3405 MIDWAY RD STE 421
PLANO TX
75093-8144
US

V. Phone/Fax

Practice location:
  • Phone: 972-801-2727
  • Fax: 972-943-3485
Mailing address:
  • Phone: 972-801-2727
  • Fax: 972-943-3485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number11400
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: