Individual
THOMAS L MAHAFFEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1107 AIRPORT RD, BLOOMINGTON, IL 61704-2544
(309) 662-3937
Mailing address
1107 AIRPORT RD, BLOOMINGTON, IL 61704-2544
(309) 353-6660
(309) 353-7664
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046008812
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046008812
—
IL
Enumeration date
06/30/2006
Last updated
01/17/2020
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