# BENJAMIN HENDRICK TICHO

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1992782494
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 156FX1202X | Optometric Technician | 036082457 | IL | — |
| 207W00000X | Ophthalmology Physician | 01070796A | IN | — |
| 207W00000X | Ophthalmology Physician | 036082457 | IL | Yes |
| 207WX0110X | Pediatric Ophthalmology and Strabismus Specialist Physician | 036082457 | IL | — |

## Other

- **Enumeration date:** 12/27/2005
- **Last updated:** 04/23/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 01621679 | BC/BS OF ILLINOIS | IL |
| 05 | — | 036082457 | — | IL |
| 01 | — | 10601008 | CAQH | IL |
| 01 | — | 10601008 | CAQH | IN |
| 01 | — | 1083684922 | GROUP NPI | — |
| 01 | — | 180046211 | MEDICARE RAILROAD | IL |
| 01 | — | 200155690 | INDIANA MEDICAID | IN |
| 01 | — | 205785 | PTAN MEDICARE COOK COUNTY IL | IL |
| 01 | — | 205786 | PTAN MEDICARE DUPAGE COUNTY IL | IL |
| 01 | — | 253350 | MEDICARE GROUP LEGACY LPI: 253350 | IN |
| 01 | — | M400068419 | MEDICARE INDIVIDUAL PIN/PTAN: M400068419 | IN |