Provider Demographics
NPI:1114105764
Name:THOMAS J CONTI MD DBA ILLINOIS OCULOPLASTIC ASSOCIATES SC
Entity Type:Organization
Organization Name:THOMAS J CONTI MD DBA ILLINOIS OCULOPLASTIC ASSOCIATES SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:CONTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-444-7200
Mailing Address - Street 1:PO BOX 459
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-0459
Mailing Address - Country:US
Mailing Address - Phone:708-747-5850
Mailing Address - Fax:708-747-9991
Practice Address - Street 1:16650 HARLEM AVE
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-1847
Practice Address - Country:US
Practice Address - Phone:708-444-7200
Practice Address - Fax:708-444-7233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108776207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036108776Medicaid
ILH95326Medicare UPIN