Provider Demographics
NPI:1124004247
Name:TABAIE, H. DAVID (OD)
Entity Type:Individual
Prefix:
First Name:H. DAVID
Middle Name:
Last Name:TABAIE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 CHAPEL ST
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3155
Mailing Address - Country:US
Mailing Address - Phone:781-762-9018
Mailing Address - Fax:781-762-8878
Practice Address - Street 1:95 CHAPEL ST
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3155
Practice Address - Country:US
Practice Address - Phone:781-762-9018
Practice Address - Fax:781-762-8878
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3462152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA22-00508OtherUNITED HEALTH CARE
MA410044860OtherRAILROAD MEDICARE
MA4270530-001OtherCIGNA
MAW15795OtherBLUE CROSS BLUE SHIELD
MA0010759OtherNEIGHBORHOOD HEALTH PLAN
MA0372030Medicaid
MA152623OtherHARVARD PILGRIM HEALTH CA
MA2516081OtherAETNA/USHC
MAT95534Medicare UPIN
MATA W17470Medicare ID - Type Unspecified