Provider Demographics
NPI:1629398144
Name:TINA R THOMAS OD LTD
Entity Type:Organization
Organization Name:TINA R THOMAS OD LTD
Other - Org Name:THOMAS EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:309-231-4134
Mailing Address - Street 1:1009 N CUMMINGS LN
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61571-9646
Mailing Address - Country:US
Mailing Address - Phone:309-231-4134
Mailing Address - Fax:309-444-7110
Practice Address - Street 1:1009 N CUMMINGS LN
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IL
Practice Address - Zip Code:61571-9646
Practice Address - Country:US
Practice Address - Phone:309-231-4134
Practice Address - Fax:309-444-7110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-07
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL215413Medicare PIN