MEDICARE: DR. TAMAR RUTH KALLUS OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OA 005755	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104906015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAMAR RUTH KALLUS OD

Provider Business Mailing Address
First Line	:	335 MAPLE ST
Second Line	:
City	:	ENGLEWOOD
State	:	NJ
Zip	:	07631-3705
Country	:	US
Telephone Number	:	201-837-2061
Fax Number	:	201-837-2061

Provider Business Practice Location Address
First Line	:	106 FERRY ST
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07105-2106
Country	:	US
Telephone Number	:	973-589-8085
Fax Number	:	973-589-2891

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	07/08/2007

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