Healthcare Provider Details

I. General information

NPI: 1912360926
Provider Name (Legal Business Name): KHALIL ANTONIO HARBIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 04/21/2025
Certification Date: 08/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9157 HUEBNER RD
SAN ANTONIO TX
78240-1502
US

IV. Provider business mailing address

FRANKFORT EYE CENTER, PSC DBA BLUEGRASS EYE CARE 100 DIAGNOSTIC DRIVE, A
FRANKFORT KY
40601
US

V. Phone/Fax

Practice location:
  • Phone: 210-697-2020
  • Fax: 210-558-7679
Mailing address:
  • Phone: 502-875-9860
  • Fax: 502-875-9887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberS4964
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: