Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 046011367 | IL |
Y | 152W00000X | Optometrist | 3581-35 | WI |
NPI | 1013564111 |
---|---|
Provider Name | Dr. Ayman Tabani |
First Address | Skokie, IL 60076-1022 |
Second Address | Kenosha, WI 53158-1945 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2019 |
Last Update Date | 22/08/2019 |