Blair Tanaka, Inc.

Primary specialty

OptometristTaxonomy code 152W00000X

License

046-008124 Issued in IL

Legal business name

BLAIR TANAKA, INC.

Practice address

402 W Boughton Rd
Suite B
Bolingbrook, IL 60440-1872

Phone

(630) 759-5100

Fax

(630) 759-5101

NPI assigned

Jul 20, 2006

Last updated

Apr 11, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Blair Tanaka, O.D.

Title

Optometrist

Phone

(630) 499-8227

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365638400000",
    "number": "1942220256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 W BOUGHTON RD",
            "address_2": "SUITE B",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604401872",
            "telephone_number": "630-759-5100",
            "fax_number": "630-759-5101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 W BOUGHTON RD",
            "address_2": "SUITE B",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604401872",
            "telephone_number": "630-759-5100",
            "fax_number": "630-759-5101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLAIR TANAKA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-20",
        "last_updated": "2013-04-11",
        "status": "A",
        "authorized_official_last_name": "TANAKA",
        "authorized_official_first_name": "BLAIR",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "630-499-8227",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046-008124",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046008124",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Bolingbrook, IL
• Providers in Bolingbrook, IL by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.