Provider Demographics
NPI:1437635091
Name:KHAWAR, BUSHRA (OD)
Entity Type:Individual
Prefix:DR
First Name:BUSHRA
Middle Name:
Last Name:KHAWAR
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 1:11 GREEN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-1253
Mailing Address - Country:US
Mailing Address - Phone:856-278-9211
Mailing Address - Fax:
Practice Address - Street 1:3046 KNIGHTS RD
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-2815
Practice Address - Country:US
Practice Address - Phone:215-639-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003427152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist