Healthcare Provider Details

I. General information

NPI: 1851220495
Provider Name (Legal Business Name): THOMAS LACH OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 W BRYN MAWR AVE # 3
CHICAGO IL
60660-4691
US

IV. Provider business mailing address

7723 W SUNSET DR
ELMWOOD PARK IL
60707-1326
US

V. Phone/Fax

Practice location:
  • Phone: 773-334-1893
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: