Provider Demographics
NPI:1154456671
Name:TWEED, MICHAEL THOMAS (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:THOMAS
Last Name:TWEED
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:1749 S RANDALL RD STE F
Mailing Address - Street 2:PEARLE VISION CENTER
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4616
Mailing Address - Country:US
Mailing Address - Phone:630-845-9110
Mailing Address - Fax:630-845-9118
Practice Address - Street 1:1749 S RANDALL RD STE F
Practice Address - Street 2:PEARLE VISION CENTER
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4616
Practice Address - Country:US
Practice Address - Phone:630-845-9110
Practice Address - Fax:630-845-9118
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist