Mahaffey, Thomas L

Mahaffey, Thomas L is an individual health care provider with primary practice located at 1107 Airport Rd , Bloomington IL 61704-2544. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Mahaffey, Thomas L can be contacted via phone (309) 662-3937.

Contact Information

Primary practice address
1107 Airport Rd Bloomington IL 61704-2544
Phone: (309) 662-3937
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 046008812 Illinois

Profile Details

NPI number 1669401139
LBN Legal business name Mahaffey, Thomas L
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 30th, 2006
Last updated Jan 17th, 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1669401139 NPPES
Illinois MEDICAID 046008812

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