Provider Demographics
NPI:1306083787
Name:KHOSHNEVIS, ALI (OD)
Entity type:Individual
Prefix:DR
First Name:ALI
Middle Name:
Last Name:KHOSHNEVIS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8320 UNIVERSITY EXEC. PARK DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-1343
Mailing Address - Country:US
Mailing Address - Phone:919-260-2747
Mailing Address - Fax:
Practice Address - Street 1:3401 N MIAMI AVE STE 102
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33127-3527
Practice Address - Country:US
Practice Address - Phone:305-571-1956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2116152W00000X
FL004330152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist