Individual
ALEX R TAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
603 MADISON ST, OAK PARK, IL 60302-4437
(708) 383-2150
Mailing address
603 MADISON ST, OAK PARK, IL 60302-4437
(708) 383-2150
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046009172
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046009172
—
IL
Enumeration date
08/31/2005
Last updated
02/06/2013
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