Provider Demographics
NPI:1154477677
Name:KHANNA EYE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:KHANNA EYE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MANOJ
Authorized Official - Middle Name:
Authorized Official - Last Name:KHANNA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:215-450-4239
Mailing Address - Street 1:5 CHESTNUT RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR KNOLLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07927
Mailing Address - Country:US
Mailing Address - Phone:215-450-4239
Mailing Address - Fax:973-588-3941
Practice Address - Street 1:178 E HANOVER AVE STE 105
Practice Address - Street 2:
Practice Address - City:CEDAR KNOLLS
Practice Address - State:NJ
Practice Address - Zip Code:07927-2038
Practice Address - Country:US
Practice Address - Phone:215-450-4239
Practice Address - Fax:973-588-3941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00611000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJPA1493-03OtherEYEMED
NJ60588OtherSPECTERA
NJ60588OtherSPECTERA
NJPA1493-03OtherEYEMED