Provider Demographics
NPI:1295774636
Name:HABASH, TESSA ROBERTS (OD)
Entity type:Individual
Prefix:DR
First Name:TESSA
Middle Name:ROBERTS
Last Name:HABASH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:TESSA
Other - Middle Name:
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:107 CROSSWIND CENTER PATH
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-6190
Mailing Address - Country:US
Mailing Address - Phone:502-863-6393
Mailing Address - Fax:
Practice Address - Street 1:107 CROSSWIND CENTER PATH
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-6190
Practice Address - Country:US
Practice Address - Phone:502-863-6393
Practice Address - Fax:502-863-0493
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1463DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYU75728Medicare UPIN