Provider Demographics
NPI:1467494583
Name:KHANNA, SEEMA (OD)
Entity Type:Individual
Prefix:
First Name:SEEMA
Middle Name:
Last Name:KHANNA
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 1:1333 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-1524
Mailing Address - Country:US
Mailing Address - Phone:631-369-0777
Mailing Address - Fax:631-369-0976
Practice Address - Street 1:1333 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-1524
Practice Address - Country:US
Practice Address - Phone:631-369-0777
Practice Address - Fax:631-369-0976
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT005867152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU70801Medicare UPIN
NYC45481Medicare ID - Type Unspecified