Provider Demographics
NPI:1437427127
Name:BENTHIEN, THOMAS R (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:R
Last Name:BENTHIEN
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 1:112 W MONROE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-1607
Mailing Address - Country:US
Mailing Address - Phone:312-236-6460
Mailing Address - Fax:312-236-8082
Practice Address - Street 1:112 W MONROE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-1607
Practice Address - Country:US
Practice Address - Phone:312-236-6460
Practice Address - Fax:312-236-8082
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2016-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.007474152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist