Provider Demographics
NPI:1902919137
Name:DR. DAVID S. TABELING, O.D. & ASSOCIATES
Entity Type:Organization
Organization Name:DR. DAVID S. TABELING, O.D. & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:TABELING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:513-753-4981
Mailing Address - Street 1:579 GARDEN WAY
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3389
Mailing Address - Country:US
Mailing Address - Phone:859-341-7377
Mailing Address - Fax:513-753-0371
Practice Address - Street 1:4601 EASTGATE BLVD
Practice Address - Street 2:SUITE C-578
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-1218
Practice Address - Country:US
Practice Address - Phone:513-753-4981
Practice Address - Fax:513-753-0371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH4882152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9307272Medicare PIN