Provider Demographics
NPI:1629267976
Name:RASA TAMULAVICHUS OD PC
Entity Type:Organization
Organization Name:RASA TAMULAVICHUS OD PC
Other - Org Name:RASA TAMULAVICHUS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RASA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMULAVICHUS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:312-550-7034
Mailing Address - Street 1:912 N HERMITAGE AVE UNIT 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-5002
Mailing Address - Country:US
Mailing Address - Phone:312-550-7034
Mailing Address - Fax:
Practice Address - Street 1:2500 W 95TH ST
Practice Address - Street 2:WALMART VISION CENTER
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2807
Practice Address - Country:US
Practice Address - Phone:708-229-0946
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty