Basic Information
| Provider Information | |||||||||
| NPI: | 1316992571 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | KHAN | ||||||||
| FirstName: | ASMA | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1950 OLD GALLOWS RD | ||||||||
| Address2: | STE 520 | ||||||||
| City: | VIENNA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221823990 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038478899 | ||||||||
| FaxNumber: | 7039910514 | ||||||||
| Practice Location | |||||||||
| Address1: | 3214 CHARLES B ROOT WYND | ||||||||
| Address2: | STE 120 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276125440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198810900 | ||||||||
| FaxNumber: | 9198810911 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 01/19/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1864 | NC | Y | Eye and Vision Services Providers | Optometrist | 152WL0500X | 1864 | NC | N | Eye and Vision Services Providers | Optometrist | Low Vision Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 093U3 | 01 | NC | BCBS | OTHER | 5904878 | 05 | NC | MEDICAID |