Individual provider Active NPI

Hajera Shahreen Khan, O.D.

  • Optometrist
  • Wheaton, IL
National Provider Identifier
1093522435
Registry record updated Dec 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
046.011929 Issued in IL
Practice address
109 Danada SQ E
Wheaton, IL 60189-2008
Phone
(331) 716-4955
NPI assigned
Dec 17, 2024
Last updated
Dec 17, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 046.011929 IL Primary

Addresses

Primary practice location

109 Danada SQ E
Wheaton, IL 60189-2008

Mailing address

109 Danada SQ E
Wheaton, IL 60189-2008
Phone (331) 716-4955

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250110000555 IL Practitioner - Optometry 7416485032 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
046.011929ILMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Visionworks Inc CurrentSince Dec 22, 2024 Accepting new patients
Visionworks, Inc CurrentSince Jan 6, 2025 Accepting new patients
Visionworks, Inc. Optometrist CurrentSince Jan 6, 2025 Accepting new patients
Southport Eye Associates LTD Optometrist Past Accepting new patients

Locations

239 Golf Mill Ctr
Ste 255
Niles, IL 60714
Phone (847) 297-2286

2422 US Highway 34
Oswego, IL 60543
Phone (630) 551-4133

109 Danada Sq E
Wheaton, IL 60189
Phone (331) 716-4955

19100 Ridgewood Pkwy
Bldg 1
San Antonio, TX 78259
Phone (726) 444-4069

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1734393600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734393600000",
    "number": "1093522435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 DANADA SQ E",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "601892008",
            "telephone_number": "331-716-4955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 DANADA SQ E",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "601892008",
            "telephone_number": "331-716-4955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAN",
        "first_name": "HAJERA",
        "middle_name": "SHAHREEN",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-12-17",
        "last_updated": "2024-12-17",
        "certification_date": "2024-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046.011929",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wheaton, IL

Sources for this page

Verify at the official NPI Registry.