Tan, Alex R

Tan, Alex R is an individual health care provider with primary practice located at 603 Madison St , Oak Park IL 60302-4437. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Tan, Alex R can be contacted via phone (708) 383-2150.

Contact Information

Primary practice address
603 Madison St Oak Park IL 60302-4437
Phone: (708) 383-2150
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 046009172 Illinois

Profile Details

NPI number 1215921655
LBN Legal business name Tan, Alex R
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 31st, 2005
Last updated Feb 6th, 2013 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1215921655 NPPES
Illinois MEDICAID 046009172

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