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General NPI Number Information
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NPI Number | 1124366190
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Entity Type | Individual
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Provider Name | FAUSTA TABE O.D.
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Gender | Female
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Dates
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Enumeration Date | 01/24/2013
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Last Update Date | 05/21/2020
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Provider Practice Location Address
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Address Line | 7135 STAPLES MILL RD
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City | RICHMOND
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State | VA
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Zip | 23228-4104
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Country | US
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Telephone | 804-264-7095
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Fax | 804-264-7097
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Provider Business Mailing Address
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Address Line | 7135 STAPLES MILL RD
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City | RICHMOND
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State | VA
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Zip | 23228-4104
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Country | US
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Telephone | 804-264-7095
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27OM00111400
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0618002183
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27OA00644800
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License Number State | NJ
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TA2324
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License Number State | MD
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