Healthcare Provider Details

I. General information

NPI: 1023201092
Provider Name (Legal Business Name): THOMAS R. CHEEZUM, O.D., LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2007
Last Update Date: 11/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 VOLVO PKWY SUITE 133
CHESAPEAKE VA
23320-2800
US

IV. Provider business mailing address

801 VOLVO PKWY SUITE 133
CHESAPEAKE VA
23320-2800
US

V. Phone/Fax

Practice location:
  • Phone: 757-549-2225
  • Fax: 757-549-0380
Mailing address:
  • Phone: 757-549-2225
  • Fax: 757-549-0380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618000025
License Number StateVA

VIII. Authorized Official

Name: DR. THOMAS RAYMOND CHEEZUM
Title or Position: OWNER
Credential: OD
Phone: 757-549-2225