Provider Demographics
NPI:1376958322
Name:THOMAS, SONY (OD)
Entity type:Individual
Prefix:DR
First Name:SONY
Middle Name:
Last Name:THOMAS
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 1:83 TEMPLETON DR STE F
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-7025
Mailing Address - Country:US
Mailing Address - Phone:630-554-8002
Mailing Address - Fax:630-554-8095
Practice Address - Street 1:83 TEMPLETON DR STE F
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-7025
Practice Address - Country:US
Practice Address - Phone:630-554-8002
Practice Address - Fax:630-554-8095
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-29
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.010800152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046010800Medicaid