MEDICARE: THOMAS MICHAEL CHESTER JR. 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	4731 T1535	OH

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	:	1598778052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS MICHAEL CHESTER JR. O.D.

Provider Business Mailing Address
First Line	:	2740 CARNEGIE AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44115-2627
Country	:	US
Telephone Number	:	216-621-6132
Fax Number	:	216-621-2803

Provider Business Practice Location Address
First Line	:	2740 CARNEGIE AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44115-2627
Country	:	US
Telephone Number	:	216-621-6132
Fax Number	:	216-621-2803

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

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	12/03/2013

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