Basic Information
| Provider Information | |||||||||
| NPI: | 1811041312 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THOMAS JOHN VISION INSTITUTE | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CORNEA CATARACT & LASER CENTER P.C. | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 967 | ||||||||
| Address2: | |||||||||
| City: | TINLEY PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604770967 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7085326029 | ||||||||
| FaxNumber: | 7085326095 | ||||||||
| Practice Location | |||||||||
| Address1: | 16532 S OAK PARK AVENUE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | TINLEY PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604770000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084292223 | ||||||||
| FaxNumber: | 7084292226 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | JOHN | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7084292223 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | DN4449 | 01 | IL | RR MEDICARE | OTHER | 31603383 | 01 | IL | BLUE CROSS BLUE SHIELD # | OTHER |