Provider Demographics
NPI:1083271027
Name:KHALID, MARIAM (OD)
Entity Type:Individual
Prefix:DR
First Name:MARIAM
Middle Name:
Last Name:KHALID
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 1:7300 EASTHAVEN LN
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1256
Mailing Address - Country:US
Mailing Address - Phone:818-439-0764
Mailing Address - Fax:
Practice Address - Street 1:9911 TOPANGA CANYON BLVD
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-3602
Practice Address - Country:US
Practice Address - Phone:818-678-9293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-24
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4456AT152W00000X
CA34818TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist