Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 046007916 | IL |
NPI | 1003945478 |
---|---|
Provider Name | Dr. Thomas W Goska |
First Address | Chicago, IL 60660-3039 |
Second Address | Chicago, IL 60618-4714 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2007 |
Last Update Date | 09/11/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
046007916 | (05) | IL |
T90844 | (02) | IL |