Provider Demographics
NPI:1235350745
Name:KHAN, NADIA SIDDIQI (OD)
Entity Type:Individual
Prefix:DR
First Name:NADIA
Middle Name:SIDDIQI
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 1:3007 HARBOR LN N STE 1500
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-5103
Mailing Address - Country:US
Mailing Address - Phone:763-559-4669
Mailing Address - Fax:763-559-4767
Practice Address - Street 1:3007 HARBOR LN N STE 1500
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-5103
Practice Address - Country:US
Practice Address - Phone:763-559-4669
Practice Address - Fax:763-559-4767
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6911TG152W00000X
MN3154152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist