MEDICARE: FORT WAYNE VISION ASSOCIATES LTD

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	18003265	IN

General Provider Information

NPI Number	:	1437494143
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORT WAYNE VISION ASSOCIATES LTD

Provider Business Mailing Address
First Line	:	515 E COLISEUM BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-1215
Country	:	US
Telephone Number	:	260-373-2033
Fax Number	:

Provider Business Practice Location Address
First Line	:	515 E COLISEUM BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-1215
Country	:	US
Telephone Number	:	260-373-2033
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ZUBAIR ASIF KHAN
Credential	:
Telephone Number	:	260-418-8089

Provider Enumeration Date	:	12/06/2012
Last Update Date	:	08/12/2021

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