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Individual

DR. MICHAEL WILLIAM THOMAS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
205 N STATE ST, MARENGO, IL 60152-2239
(815) 568-6508
(815) 568-4896
Mailing address
205 N STATE ST, MARENGO, IL 60152-2239
(815) 568-6508
(815) 568-4896

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046-009334
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00049324111
BLUE CROSS BLUE SHIELD
IL
05
046009334
IL
Enumeration date
04/25/2006
Last updated
08/23/2010
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