Provider Demographics
NPI:1437494143
Name:FORT WAYNE VISION ASSOCIATES LTD
Entity Type:Organization
Organization Name:FORT WAYNE VISION ASSOCIATES LTD
Other - Org Name:EYE SPECS ON MAIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ZUBAIR
Authorized Official - Middle Name:ASIF
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-418-8089
Mailing Address - Street 1:515 E COLISEUM BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-1215
Mailing Address - Country:US
Mailing Address - Phone:260-373-2033
Mailing Address - Fax:
Practice Address - Street 1:515 E COLISEUM BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-1215
Practice Address - Country:US
Practice Address - Phone:260-373-2033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-06
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003265152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty