Healthcare Provider Details

I. General information

NPI: 1629153028
Provider Name (Legal Business Name): KAY & TABAS OPHTHALMOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 11/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 MONUMENT RD SUITE 110
BALA CYNWYD PA
19004-1723
US

IV. Provider business mailing address

601 WALNUT ST SUITE L30
PHILADELPHIA PA
19106-3332
US

V. Phone/Fax

Practice location:
  • Phone: 610-667-6760
  • Fax: 610-667-7206
Mailing address:
  • Phone: 215-925-6402
  • Fax: 215-925-0262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberMD012768E
License Number StatePA

VIII. Authorized Official

Name: DR. MICHAEL L KAY
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 215-925-6402