MEDICARE: SPOGMAI KHAN OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	NA	VA

General Provider Information

NPI Number	:	1023946969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SPOGMAI KHAN OD

Provider Business Mailing Address
First Line	:	26074 HUNTWICK GLEN SQ
Second Line	:
City	:	ALDIE
State	:	VA
Zip	:	20105-5715
Country	:	US
Telephone Number	:	703-945-2450
Fax Number	:

Provider Business Practice Location Address
First Line	:	241 CORPORATE BLVD
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23502-4975
Country	:	US
Telephone Number	:	757-622-2200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2026
Last Update Date	:	06/04/2026

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