Basic Information
| Provider Information | |||||||||
| NPI: | 1104420983 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KHAN | ||||||||
| FirstName: | TEHREEM | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 424 COLLEEN CT | ||||||||
| Address2: | |||||||||
| City: | TOMS RIVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087557325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2766180736 | ||||||||
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| Practice Location | |||||||||
| Address1: | 588 ROUTE 70 STE 9 | ||||||||
| Address2: | |||||||||
| City: | BRICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087234023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7328640755 | ||||||||
| FaxNumber: | 7328641607 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2020 | ||||||||
| LastUpdateDate: | 11/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 27OA00701900 | NJ | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.