Provider Demographics
NPI:1972158798
Name:KHAN, TAHERA MISHAL (OD)
Entity type:Individual
Prefix:DR
First Name:TAHERA
Middle Name:MISHAL
Last Name:KHAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:TAHERA
Other - Middle Name:
Other - Last Name:NAAZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:323 UNION HILL RD
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-1800
Mailing Address - Country:US
Mailing Address - Phone:732-567-2472
Mailing Address - Fax:
Practice Address - Street 1:509 STILLWELLS CORNER RD STE E5
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2965
Practice Address - Country:US
Practice Address - Phone:732-431-3312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00691800152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist