Provider Demographics
NPI:1043879000
Name:DR. TERRRY KHRAISHI OD INC
Entity Type:Organization
Organization Name:DR. TERRRY KHRAISHI OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARIQ
Authorized Official - Middle Name:T
Authorized Official - Last Name:KHRAISHI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:310-864-9323
Mailing Address - Street 1:317 W PACIFIC COAST HWY STE B
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:90744-2542
Mailing Address - Country:US
Mailing Address - Phone:424-264-5821
Mailing Address - Fax:424-264-5821
Practice Address - Street 1:317 W PACIFIC COAST HWY STE B
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:CA
Practice Address - Zip Code:90744-2542
Practice Address - Country:US
Practice Address - Phone:424-264-5821
Practice Address - Fax:424-264-5821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-12
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty