Provider Demographics
NPI:1922073139
Name:TABACHNICK, WAYNE NEAL (OD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:NEAL
Last Name:TABACHNICK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7 COUNTRY MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-2026
Mailing Address - Country:US
Mailing Address - Phone:631-367-6368
Mailing Address - Fax:718-782-1548
Practice Address - Street 1:48 GRAHAM AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-4002
Practice Address - Country:US
Practice Address - Phone:718-388-7400
Practice Address - Fax:718-782-1548
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV002974152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00663685Medicaid
NYC30892Medicare PIN
NYC30891Medicare PIN