Provider Demographics
NPI:1891801858
Name:KHAMEES, KHALED M (OD , MS)
Entity Type:Individual
Prefix:
First Name:KHALED
Middle Name:M
Last Name:KHAMEES
Suffix:
Gender:M
Credentials:OD , MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-2124
Mailing Address - Country:US
Mailing Address - Phone:614-882-7786
Mailing Address - Fax:614-882-1012
Practice Address - Street 1:50 N STATE ST
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-2124
Practice Address - Country:US
Practice Address - Phone:614-882-7786
Practice Address - Fax:614-882-1012
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH5095 / T1981152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4030373Medicare ID - Type UnspecifiedPROVIDER IDENTIFIER #
OHU81387Medicare UPIN