Individual
DR. LISA THATCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
046-009535
IL
152W00000X
Optometrist
Primary
2003014792
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046009535
—
IL
01
—
0814870010
MEDICARE NSC NUMBER
IL
01
—
0814870023
MEDICARE NSC NUMBER
IL
01
—
0814870026
MEDICARE NSC NUMBER
IL
01
—
087817
HEALTH ALLIANCE
—
01
—
252039
HARMONY HEALTH PLAN
—
01
—
IL9535
EYEMED
—
01
—
P00040122
MEDICARE RAILROAD
IL
Enumeration date
05/12/2006
Last updated
04/12/2019
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