Provider Demographics
NPI:1518552041
Name:AHSAN-KHAN, MAYISHA (OD)
Entity type:Individual
Prefix:DR
First Name:MAYISHA
Middle Name:
Last Name:AHSAN-KHAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MAYISHA
Other - Middle Name:
Other - Last Name:AHSAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:63 WINDSOR ROAD
Mailing Address - Street 2:
Mailing Address - City:ETOBICOKE
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:M9R 3G6
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19861 FOOTHILL AVE
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-1611
Practice Address - Country:US
Practice Address - Phone:647-338-2379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-05
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3222152W00000X
VA0618002995152W00000X
FLTPOP57152W00000X
WI3731-35152W00000X
NY009310152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist