Provider Demographics
NPI:1508050527
Name:MICAH, KWEKU (OD)
Entity Type:Individual
Prefix:DR
First Name:KWEKU
Middle Name:
Last Name:MICAH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 688
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45071-0688
Mailing Address - Country:US
Mailing Address - Phone:513-662-0157
Mailing Address - Fax:
Practice Address - Street 1:6180 GLENWAY AVE
Practice Address - Street 2:UNIT H
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-6320
Practice Address - Country:US
Practice Address - Phone:513-662-0157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-03
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5732152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3005116Medicaid