Provider Demographics
NPI:1245340827
Name:TABLANTE, RITA R (MD)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:R
Last Name:TABLANTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 SW CORPORATE VIEW
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66615-1233
Mailing Address - Country:US
Mailing Address - Phone:785-235-3322
Mailing Address - Fax:785-246-6258
Practice Address - Street 1:619 SW CORPORATE VIEW
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66615-1233
Practice Address - Country:US
Practice Address - Phone:785-235-3322
Practice Address - Fax:785-246-6258
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-28223207W00000X
KS0428223207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS056924OtherBCBS OF KS
KS180037324OtherPALMETTO GBA
KS100346000AMedicaid
KS100346000AMedicaid
KS056924OtherBCBS OF KS