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General NPI Number Information
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NPI Number | 1275605438
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Entity Type | Individual
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Provider Name | MICHAEL TANTOCO ARGAO O.D.
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Gender | Male
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 08/24/2021
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Provider Practice Location Address
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Address Line | 4979 INDIANA AVE STE 200
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City | LISLE
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State | IL
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Zip | 60532-3848
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Country | US
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Telephone | 630-598-5120
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Fax |
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Provider Business Mailing Address
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Address Line | 9221 KESWICK DR
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City | WOODRIDGE
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State | IL
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Zip | 60517-7673
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Country | US
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Telephone | 630-343-9714
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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 | 46009487
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License Number State | IL
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