Provider Demographics
NPI:1003945478
Name:GOSKA, THOMAS W (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:W
Last Name:GOSKA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6007 N SHERIDAN RD
Mailing Address - Street 2:#33C
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-3039
Mailing Address - Country:US
Mailing Address - Phone:773-769-2040
Mailing Address - Fax:
Practice Address - Street 1:3627 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-4714
Practice Address - Country:US
Practice Address - Phone:773-525-2022
Practice Address - Fax:773-525-2024
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-03
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046007916152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046007916Medicaid
ILT90844Medicare UPIN
IL367501Medicare ID - Type Unspecified