Provider Demographics
NPI:1083591804
Name:ACOSTA, KHABIRAH (OD)
Entity type:Individual
Prefix:DR
First Name:KHABIRAH
Middle Name:
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6656 GERMANTOWN AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-2105
Mailing Address - Country:US
Mailing Address - Phone:215-842-5939
Mailing Address - Fax:215-842-5937
Practice Address - Street 1:6656 GERMANTOWN AVE STE 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-2105
Practice Address - Country:US
Practice Address - Phone:215-842-5939
Practice Address - Fax:215-842-5937
Is Sole Proprietor?:No
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAA0006393672152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist