Provider Demographics
NPI:1346336492
Name:KAY & TABAS OPHTHALMOLOGY
Entity Type:Organization
Organization Name:KAY & TABAS OPHTHALMOLOGY
Other - Org Name:KT OPTICAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:KAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-925-6402
Mailing Address - Street 1:601 WALNUT ST
Mailing Address - Street 2:SUITE L30
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19106
Mailing Address - Country:US
Mailing Address - Phone:215-925-6402
Mailing Address - Fax:215-925-0262
Practice Address - Street 1:601 WALNUT ST
Practice Address - Street 2:SUITE L30
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19106
Practice Address - Country:US
Practice Address - Phone:215-925-6402
Practice Address - Fax:215-925-0262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD012768E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014921990004Medicaid
PA0943390002Medicare ID - Type Unspecified
C32883Medicare UPIN