Provider Demographics
NPI:1427148725
Name:TAMULAVICHUS, RASA (OD)
Entity type:Individual
Prefix:
First Name:RASA
Middle Name:
Last Name:TAMULAVICHUS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:RASA
Other - Middle Name:
Other - Last Name:GRAFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 16974
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-0980
Mailing Address - Country:US
Mailing Address - Phone:312-550-7034
Mailing Address - Fax:708-229-0973
Practice Address - Street 1:2500 W 95TH ST
Practice Address - Street 2:WALMART VISION CENTER
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2807
Practice Address - Country:US
Practice Address - Phone:708-229-0946
Practice Address - Fax:708-229-0973
Is Sole Proprietor?:No
Enumeration Date:2006-10-15
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-009691152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist