Provider Demographics
NPI:1801003504
Name:KHAN, SHABANA (OD)
Entity Type:Individual
Prefix:DR
First Name:SHABANA
Middle Name:
Last Name:KHAN
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 1:1721 N CUSTER RD
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-3274
Mailing Address - Country:US
Mailing Address - Phone:972-540-2020
Mailing Address - Fax:972-540-2010
Practice Address - Street 1:1721 N CUSTER RD
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-3274
Practice Address - Country:US
Practice Address - Phone:972-540-2020
Practice Address - Fax:972-540-2010
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6442TG152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management