Provider Demographics
NPI:1588603914
Name:HABASH, KEFAH (OD)
Entity Type:Individual
Prefix:DR
First Name:KEFAH
Middle Name:
Last Name:HABASH
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 1:108 OSBORNE WAY
Mailing Address - Street 2:STE7
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-9693
Mailing Address - Country:US
Mailing Address - Phone:859-312-7948
Mailing Address - Fax:502-863-0493
Practice Address - Street 1:108 OSBORNE WAY
Practice Address - Street 2:STE 7
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-9693
Practice Address - Country:US
Practice Address - Phone:502-863-6393
Practice Address - Fax:502-863-0493
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1409DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77014090Medicaid
KY77014090Medicaid
KY5871210001Medicare NSC
KY00047001Medicare PIN
KY0550003Medicare ID - Type Unspecified