Samala M Khan, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

TA2243 Issued in MD

Practice address

18310 Montgomery Village Ave Ste 140
Gaithersburg, MD 20879-3556

Phone

(301) 869-4070

Fax

(301) 869-0397

NPI assigned

Mar 6, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in DC

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

Specialty

Optometry

Education

New England College of Optometry, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Aeg Maryland Professional LLCGroup PAC ID 7618316902, 20 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Aeg Maryland Professional LLC

  • Optometrist
  • Gaithersburg, MD
  • NPI 1962182782

  DC

  Medicare reassignment Care Compare group NPD
• Montgomery Village Eye Center Inc

  dba Montgomery village Eye Center

  • Optometrist
  • Gaithersburg, MD
  • NPI 1871937268

  DC

  Medicare reassignment NPD
• Daniel Poth, O.D. and Associates, P.C.

  dba Visionworks Doctors of Optometry

  • Eyewear Supplier
  • Alexandria, VA
  • NPI 1063454460

  Optometrist

  NPD (past)

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

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664496000000",
    "number": "1235269853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18310 MONTGOMERY VILLAGE AVE STE 140",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208793556",
            "telephone_number": "301-869-4070",
            "fax_number": "301-869-0397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18310 MONTGOMERY VILLAGE AVE STE 140",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208793556",
            "telephone_number": "301-869-4070",
            "fax_number": "301-869-0397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAN",
        "first_name": "SAMALA",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-06",
        "last_updated": "2022-09-30",
        "certification_date": "2022-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MD",
            "license": "TA2243",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "2B2375",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katherine Leanne Keyser, DPT
• Muge Khalaf, LGPC
• Ahmna Khan
• Ana Khan
• Fatima Tabassum Khan, M.D.
• Mitra Khanjani, LCSW-C
• Kheni Pharmacy LLC (Healthwise Pharmacy)
• Rafie Khosbin
• Christine Leung Kiang, PT, DPT
• Paul Thomas Fathay Kiawu

• Optometrist in Gaithersburg, MD
• Providers in Gaithersburg, MD by specialty
• Optometrist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.