Provider Demographics
NPI:1124366190
Name:TABE, FAUSTA (OD)
Entity Type:Individual
Prefix:DR
First Name:FAUSTA
Middle Name:
Last Name:TABE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7135 STAPLES MILL RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23228-4104
Mailing Address - Country:US
Mailing Address - Phone:804-264-7095
Mailing Address - Fax:
Practice Address - Street 1:7135 STAPLES MILL RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23228-4104
Practice Address - Country:US
Practice Address - Phone:804-264-7095
Practice Address - Fax:804-264-7097
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-24
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OM00111400152W00000X
VA0618002183152W00000X
NJ27OA00644800152W00000X
MDTA2324152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist