Provider Demographics
NPI:1598778052
Name:CHESTER, THOMAS MICHAEL JR (OD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:MICHAEL
Last Name:CHESTER
Suffix:JR
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 1:2740 CARNEGIE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-2627
Mailing Address - Country:US
Mailing Address - Phone:216-621-6132
Mailing Address - Fax:216-621-2803
Practice Address - Street 1:2740 CARNEGIE AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-2627
Practice Address - Country:US
Practice Address - Phone:216-621-6132
Practice Address - Fax:216-621-2803
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4731 T1535152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0386381Medicaid
OH0814062Medicare PIN
OHU63890Medicare UPIN