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General NPI Number Information
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NPI Number | 1083271027
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Entity Type | Individual
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Provider Name | MARIAM KHALID OD
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Gender | Female
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Dates
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Enumeration Date | 05/24/2019
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 11151 TAMPA AVE
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City | NORTHRIDGE
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State | CA
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Zip | 91326-2254
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Country | US
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Telephone | 818-366-9664
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Fax |
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Provider Business Mailing Address
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Address Line | 7300 EASTHAVEN LN
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City | WEST HILLS
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State | CA
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Zip | 91307-1256
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Country | US
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Telephone | 818-439-0764
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 34818TLG
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4456AT
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License Number State | OR
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