Healthcare Provider Details

I. General information

NPI: 1346336492
Provider Name (Legal Business Name): KAY & TABAS OPHTHALMOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 11/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 WALNUT ST SUITE L30
PHILA PA
19106
US

IV. Provider business mailing address

601 WALNUT ST SUITE L30
PHILA PA
19106
US

V. Phone/Fax

Practice location:
  • Phone: 215-925-6402
  • Fax: 215-925-0262
Mailing address:
  • Phone: 215-925-6402
  • Fax: 215-925-0262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD012768E
License Number StatePA

VIII. Authorized Official

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