Provider Demographics
NPI:1629153028
Name:KAY & TABAS OPHTHALMOLOGY
Entity Type:Organization
Organization Name:KAY & TABAS OPHTHALMOLOGY
Other - Org Name:ONSITE 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:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-3332
Mailing Address - Country:US
Mailing Address - Phone:215-925-6402
Mailing Address - Fax:215-925-0262
Practice Address - Street 1:50 MONUMENT RD
Practice Address - Street 2:SUITE 110
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1723
Practice Address - Country:US
Practice Address - Phone:610-667-6760
Practice Address - Fax:610-667-7206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD012768E156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014921990004Medicaid
PAC32883Medicare UPIN
PA0943390001Medicare ID - Type Unspecified