MEDICARE: DR. THOMAS W GOSKA O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	046007916	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003945478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS W GOSKA O.D.

Provider Business Mailing Address
First Line	:	6007 N SHERIDAN RD
Second Line	:	#33C
City	:	CHICAGO
State	:	IL
Zip	:	60660-3039
Country	:	US
Telephone Number	:	773-769-2040
Fax Number	:

Provider Business Practice Location Address
First Line	:	3627 N WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-4714
Country	:	US
Telephone Number	:	773-525-2022
Fax Number	:	773-525-2024

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2007
Last Update Date	:	11/09/2017

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