Gustafson, Thomas Earl
Gustafson, Thomas Earl is an individual health care provider with primary practice located at 96 W Northwest Hwy , Palatine IL 60067-3571. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Gustafson, Thomas Earl can be contacted via phone (847) 358-7722.Contact Information
Primary practice address
96 W Northwest Hwy
Palatine IL 60067-3571
Phone: (847) 358-7722
Fax: (847) 934-0661
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 046008241 | Illinois |
Profile Details
| NPI number | 1164492096 |
|---|---|
| LBN Legal business name | Gustafson, Thomas Earl |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 24th, 2006 |
| Last updated | Mar 13th, 2020 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1164492096 | NPPES |
| Illinois | MEDICAID | 046008241 |
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