Healthcare Provider Details

I. General information

NPI: 1083591804
Provider Name (Legal Business Name): KHABIRAH ACOSTA OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2025
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date: 04/26/2026
Reactivation Date: 08/17/2026

III. Provider practice location address

160 N GULPH RD STE 2350
KING OF PRUSSIA PA
19406-3560
US

IV. Provider business mailing address

160 N GULPH RD STE 2350
KING OF PRUSSIA PA
19406-3560
US

V. Phone/Fax

Practice location:
  • Phone: 610-510-8581
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEP008595
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: