Individual
MRS. TINA RENEE THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
8921 N WOOD SAGE RD, PEORIA, IL 61615-7822
(309) 243-2400
(309) 243-7918
Mailing address
8921 N WOOD SAGE RD, PEORIA, IL 61615-7822
(309) 243-3869
(309) 243-7918
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046008635
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046008635
—
IL
01
—
09030205
BLUE CROSS BLUE SHIELD
IL
Enumeration date
07/18/2005
Last updated
07/28/2020
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