Healthcare Provider Details

I. General information

NPI: 1508807496
Provider Name (Legal Business Name): DAVID SCOTT TABELING O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 11/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7426 BEECHMONT AVE SUITE 209
CINCINNATI OH
45255-4104
US

IV. Provider business mailing address

579 GARDEN WAY
EDGEWOOD KY
41017-3389
US

V. Phone/Fax

Practice location:
  • Phone: 513-232-2230
  • Fax: 513-232-2245
Mailing address:
  • Phone: 859-341-7377
  • Fax: 513-232-2245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOH4882
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: