Provider Demographics
NPI:1518954163
Name:KIRCHGESSNER, THOMAS C (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:C
Last Name:KIRCHGESSNER
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 1:8921 N. WOOD SAGE RD.
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-7822
Mailing Address - Country:US
Mailing Address - Phone:309-243-2400
Mailing Address - Fax:309-243-7918
Practice Address - Street 1:8921 N. WOOD SAGE RD.
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-7822
Practice Address - Country:US
Practice Address - Phone:309-243-2400
Practice Address - Fax:309-243-7918
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009250152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046009250Medicaid
0425500001Medicare NSC
U80369Medicare UPIN