Individual
BENJAMIN HENDRICK TICHO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10436 SOUTHWEST HIGHWAY, CHICAGO RIDGE, IL 60415-2282
(708) 423-4070
(708) 423-4216
Mailing address
10436 SOUTHWEST HWY STE 1, CHICAGO RIDGE, IL 60415-2284
(708) 952-0109
(708) 952-0329
Taxonomy
Speciality
Code
Description
License number
State
156FX1202X
Optometric Technician
036082457
IL
207W00000X
Ophthalmology Physician
01070796A
IN
207W00000X
Ophthalmology Physician
Primary
036082457
IL
207WX0110X
Pediatric Ophthalmology and Strabismus Specialist Physician
036082457
IL
Other
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
INDIVIDUAL LEGACY PROVIDER
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
Enumeration date
12/27/2005
Last updated
04/23/2020
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