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General NPI Number Information
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NPI Number | 1144314675
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Entity Type | Individual
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Provider Name | SAIRA NISHATH KHAN O.D.
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Gender | Female
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 06/17/2024
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Provider Practice Location Address
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Address Line | 28804 GRATIOT AVE
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City | ROSEVILLE
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State | MI
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Zip | 48066-4235
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Country | US
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Telephone | 630-276-6285
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Fax |
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Provider Business Mailing Address
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Address Line | 32406 FRANKLIN RD UNIT 250125
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City | FRANKLIN
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State | MI
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Zip | 48025-7004
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Country | US
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Telephone | 630-276-6285
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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 | 02332
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License Number State | IA
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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 | 046010925
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4901004366
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License Number State | MI
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