Provider Demographics
NPI:1790019743
Name:BUKHARI, FATIMA Z (OD)
Entity Type:Individual
Prefix:DR
First Name:FATIMA
Middle Name:Z
Last Name:BUKHARI
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 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:
Practice Address - Street 1:522 DEMPSTER ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-1303
Practice Address - Country:US
Practice Address - Phone:847-864-5200
Practice Address - Fax:847-864-1231
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT030.0133978152W00000X
NYTUV009717152W00000X
IL046010203152W00000X
FLTPOP90152W00000X
IA118668152W00000X
MAOPT5265152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist