Provider Demographics
NPI:1265487607
Name:KHUDAIRI, NABEEL (OD)
Entity Type:Individual
Prefix:DR
First Name:NABEEL
Middle Name:
Last Name:KHUDAIRI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 COTTAGE ST E
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3532
Mailing Address - Country:US
Mailing Address - Phone:781-762-5455
Mailing Address - Fax:
Practice Address - Street 1:54 COTTAGE ST E
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3532
Practice Address - Country:US
Practice Address - Phone:781-762-5455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3517152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0369314Medicaid
MAU34121Medicare UPIN
MA0712640001Medicare NSC
MAKH457858Medicare ID - Type Unspecified