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General NPI Number Information
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NPI Number | 1992782494
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Entity Type | Individual
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Provider Name | BENJAMIN HENDRICK TICHO MD
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Gender | Male
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Dates
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Enumeration Date | 12/27/2005
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Last Update Date | 04/23/2020
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Provider Practice Location Address
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Address Line | 10436 SOUTHWEST HIGHWAY
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City | CHICAGO RIDGE
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State | IL
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Zip | 60415-2282
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Country | US
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Telephone | 708-423-4070
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Fax | 708-423-4216
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Provider Business Mailing Address
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Address Line | 10436 SOUTHWEST HWY STE 1
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City | CHICAGO RIDGE
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State | IL
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Zip | 60415-2284
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Country | US
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Telephone | 708-952-0109
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Fax | 708-952-0329
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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 | 156FX1202X
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Taxonomy Name | Optometric Technician
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License Number | 036082457
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 01070796A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 207WX0110X
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Taxonomy Name | Pediatric Ophthalmology and Strabismus Specialist Physician Physician
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License Number | 036082457
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 036082457
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License Number State | IL
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