Provider Demographics
NPI:1801011937
Name:ATASHIRANG, GHASSEM KHAN (OD PHD)
Entity Type:Individual
Prefix:DR
First Name:GHASSEM
Middle Name:KHAN
Last Name:ATASHIRANG
Suffix:
Gender:M
Credentials:OD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 COURAGEOUS DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROCKWELL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-5769
Mailing Address - Country:US
Mailing Address - Phone:972-772-1800
Mailing Address - Fax:972-772-1800
Practice Address - Street 1:2130 S BUCKNER BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-8601
Practice Address - Country:US
Practice Address - Phone:214-381-1700
Practice Address - Fax:214-381-1497
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX03756152WC0802X, 152WX0102X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX526446OtherOE NUMBER OPTOMETIC EDUCA
TX910075OtherEYE MED
TXGOOOE78S6Medicaid
TX910075OtherEYE MED