Protiva Shooprova Khan, OD is a medicare enrolled "Optometrist" provider in Mariposa, California. Her current practice location is
5192 Hospital Road, Mariposa, California. You can reach out to her office (for appointments etc.) via phone at
(209) 742-6144.
Protiva Shooprova Khan is licensed to practice in California (license number 34680) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1902327240.
Healthcare Provider's Profile
| Full Name | Protiva Shooprova Khan |
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| Gender | Female |
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| Speciality | Optometrist |
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| Location | 5192 Hospital Road, Mariposa, California |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1902327240
- Provider Enumeration Date: 06/27/2017
- Last Update Date: 11/01/2021
Medicare PECOS Information:
- PECOS PAC ID: 7810249968
- Enrollment ID: I20210318002480
Medical Identifiers
Medical identifiers for Protiva Shooprova Khan such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1902327240 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 152W00000X | Optometrist | TUV008592-1 (New York) | Secondary |
| 152W00000X | Optometrist | 34680 (California) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Protiva Shooprova Khan allows following entities to bill medicare on her behalf.
| Provider Name | Dr Matthew B Lee Od Inc |
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| Provider Type | Part B Supplier - Clinic/group Practice |
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| Provider Identifiers | NPI Number: 1770122061
PECOS PAC ID: 7911333752
Enrollment ID: O20200214000327 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Protiva Shooprova Khan is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Protiva Shooprova Khan, OD
2912 Willowbrook Dr Apt 3,
Merced, CA 95348-1301
Ph: (213) 820-6350 | Protiva Shooprova Khan, OD
5192 Hospital Road,
Mariposa, CA 95338
Ph: (209) 742-6144 |
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