Provider Demographics
NPI:1598771537
Name:OBRIEN, THOMAS MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MICHAEL
Last Name:OBRIEN
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 1:5706 111TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60415-2407
Mailing Address - Country:US
Mailing Address - Phone:708-636-5115
Mailing Address - Fax:708-636-5162
Practice Address - Street 1:5706 111TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60415-2407
Practice Address - Country:US
Practice Address - Phone:708-636-5115
Practice Address - Fax:708-636-5162
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-007561152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL694820Medicare PIN
ILP00837520Medicare PIN
ILT37927Medicare UPIN
IL0334230001Medicare NSC