Provider Demographics
NPI:1144314675
Name:KHAN, SAIRA NISHATH (OD)
Entity type:Individual
Prefix:DR
First Name:SAIRA
Middle Name:NISHATH
Last Name:KHAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32406 FRANKLIN RD UNIT 250125
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MI
Mailing Address - Zip Code:48025-7004
Mailing Address - Country:US
Mailing Address - Phone:630-276-6285
Mailing Address - Fax:
Practice Address - Street 1:28804 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4235
Practice Address - Country:US
Practice Address - Phone:630-276-6285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02332152W00000X
IL046010925152W00000X
MI4901004366152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7943352Medicaid
MI900E03238OtherBCBS PIN