Provider Demographics
NPI:1023201092
Name:THOMAS R. CHEEZUM, O.D., LTD
Entity Type:Organization
Organization Name:THOMAS R. CHEEZUM, O.D., LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:CHEEZUM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:757-549-2225
Mailing Address - Street 1:801 VOLVO PKWY
Mailing Address - Street 2:SUITE 133
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2800
Mailing Address - Country:US
Mailing Address - Phone:757-549-2225
Mailing Address - Fax:757-549-0380
Practice Address - Street 1:801 VOLVO PKWY
Practice Address - Street 2:SUITE 133
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2800
Practice Address - Country:US
Practice Address - Phone:757-549-2225
Practice Address - Fax:757-549-0380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000025152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0974030001Medicare NSC
C09800Medicare PIN
VADS4375Medicare PIN