Provider Demographics
NPI:1801664255
Name:MARZUKA KHAN JALAL OD PLLC
Entity type:Organization
Organization Name:MARZUKA KHAN JALAL OD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARZUKA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN JALAL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:734-981-8111
Mailing Address - Street 1:43271 FORD RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3340
Mailing Address - Country:US
Mailing Address - Phone:734-981-8111
Mailing Address - Fax:734-981-2327
Practice Address - Street 1:43271 FORD RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3340
Practice Address - Country:US
Practice Address - Phone:734-981-8111
Practice Address - Fax:734-981-2327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier