Provider Demographics
NPI:1225065758
Name:BOCK, THOMAS M (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:BOCK
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:300 S STATE ST
Mailing Address - Street 2:SUITE #15
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-1676
Mailing Address - Country:US
Mailing Address - Phone:616-772-9149
Mailing Address - Fax:616-772-2906
Practice Address - Street 1:300 S STATE ST
Practice Address - Street 2:SUITE #15
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-1676
Practice Address - Country:US
Practice Address - Phone:616-772-9149
Practice Address - Fax:616-772-2906
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2013-04-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4901002735152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0G07612001Medicare PIN
MIU38793Medicare UPIN
MI0603840001Medicare NSC