=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912360926
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KHALIL ANTONIO HARBIE MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2016
-----------------------------------------------------
Last Update Date | 04/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9157 HUEBNER RD
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78240-1502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-697-2020
-----------------------------------------------------
Fax | 210-558-7679
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | FRANKFORT EYE CENTER, PSC DBA BLUEGRASS EYE CARE 100 DIAGNOSTIC DRIVE, A
-----------------------------------------------------
City | FRANKFORT
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-875-9860
-----------------------------------------------------
Fax | 502-875-9887
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | S4964
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------