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General NPI Number Information
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NPI Number | 1972158798
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Entity Type | Individual
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Provider Name | TAHERA MISHAL KHAN OD
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Gender | Female
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Dates
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Enumeration Date | 08/08/2019
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Last Update Date | 12/31/2019
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Provider Practice Location Address
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Address Line | 509 STILLWELLS CORNER RD STE E5
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City | FREEHOLD
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State | NJ
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Zip | 07728-2965
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Country | US
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Telephone | 732-431-3312
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Fax |
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Provider Business Mailing Address
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Address Line | 323 UNION HILL RD
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City | MANALAPAN
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State | NJ
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Zip | 07726-1800
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Country | US
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Telephone | 732-567-2472
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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 | 27OA00691800
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License Number State | NJ
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