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General NPI Number Information
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NPI Number | 1992710578
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Entity Type | Individual
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Provider Name | ERWIN CABELA O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4113 SAINT CHARLES RD
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City | BELLWOOD
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State | IL
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Zip | 60104-1145
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Country | US
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Telephone | 708-493-9306
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Fax | 708-493-0144
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Provider Business Mailing Address
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Address Line | 801 12TH AVE
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City | LA GRANGE
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State | IL
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Zip | 60525-3118
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Country | US
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Telephone | 708-369-7346
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Fax | 708-493-0144
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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 | 046009094
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License Number State | IL
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