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General NPI Number Information
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NPI Number | 1710769872
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Entity Type | Individual
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Provider Name | IMRAN KHAN OD
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Gender | Male
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Dates
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Enumeration Date | 10/13/2023
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Last Update Date | 01/08/2026
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Provider Practice Location Address
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Address Line | 1503 3RD AVE
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City | NEW YORK
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State | NY
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Zip | 10028-2116
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Country | US
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Telephone | 917-244-1265
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Fax |
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Provider Business Mailing Address
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Address Line | 1269 E 40TH ST
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City | BROOKLYN
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State | NY
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Zip | 11210-4958
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Country | US
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Telephone | 917-244-1265
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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 | 27OM00204000
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License Number State | NJ
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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 | 009789
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License Number State | NY
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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 | 27OA00736100
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License Number State | NJ
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