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General NPI Number Information
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NPI Number | 1528360468
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Entity Type | Organization
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Legal Business Name | DAVID J TABAK O D LTD
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Dates
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Enumeration Date | 11/29/2010
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Last Update Date | 07/06/2012
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Provider Practice Location Address
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Address Line | 232 E MAIN ST
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City | BARRINGTON
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State | IL
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Zip | 60010-3225
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Country | US
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Telephone | 847-382-2020
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Fax | 847-382-1241
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Provider Business Mailing Address
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Address Line | 232 E MAIN ST
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City | BARRINGTON
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State | IL
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Zip | 60010-3225
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Country | US
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Telephone | 847-382-2020
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Fax | 847-382-1241
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID J TABAK
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Credential | O.D.
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Telephone | 847-382-2020
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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 | 04600705
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License Number State | IL
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