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General NPI Number Information
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NPI Number | 1144492497
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Entity Type | Organization
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Legal Business Name | WAYNE TABACHNICK, OD PC
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Dates
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Enumeration Date | 03/27/2008
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Last Update Date | 03/27/2008
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Provider Practice Location Address
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Address Line | 48 GRAHAM AVE
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City | BROOKLYN
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State | NY
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Zip | 11206-4002
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Country | US
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Telephone | 718-388-7400
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Fax | 718-782-1548
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Provider Business Mailing Address
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Address Line | 65 VILLAS CIR
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City | MELVILLE
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State | NY
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Zip | 11747-3061
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Country | US
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Telephone | 631-420-0803
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WAYNE N TABACHNICK
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Credential | O.D.
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Telephone | 718-388-7400
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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 | TUV002974
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License Number State | NY
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