Provider Demographics
NPI:1528110533
Name:THOMAN, SYLVIA (OD)
Entity type:Individual
Prefix:DR
First Name:SYLVIA
Middle Name:
Last Name:THOMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 TAMARACK DR
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-1513
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:575 S PERRYVILLE RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2530
Practice Address - Country:US
Practice Address - Phone:815-315-9358
Practice Address - Fax:815-397-4684
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.009647152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4515286OtherBCBS
IL4515286OtherBCBS
IL363546473OtherEIN
IL0253870001Medicare ID - Type UnspecifiedMEDICARE MATERIALS
IL799670Medicare ID - Type UnspecifiedGROUP #
IL4515286OtherBCBS