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General NPI Number Information
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NPI Number | 1003945478
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Entity Type | Individual
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Provider Name | THOMAS W GOSKA O.D.
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Gender | Male
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Dates
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Enumeration Date | 03/03/2007
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Last Update Date | 11/09/2017
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Provider Practice Location Address
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Address Line | 3627 N WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60618-4714
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Country | US
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Telephone | 773-525-2022
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Fax | 773-525-2024
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Provider Business Mailing Address
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Address Line | 6007 N SHERIDAN RD #33C
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City | CHICAGO
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State | IL
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Zip | 60660-3039
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Country | US
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Telephone | 773-769-2040
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046007916
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License Number State | IL
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