Provider Demographics
NPI:1558466003
Name:YOCHEM, THOMAS E (OD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:E
Last Name:YOCHEM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 W 3RD ST
Mailing Address - Street 2:PO BOX 999
Mailing Address - City:ANACONDA
Mailing Address - State:MT
Mailing Address - Zip Code:59711-2205
Mailing Address - Country:US
Mailing Address - Phone:406-563-5141
Mailing Address - Fax:
Practice Address - Street 1:112 W 3RD ST
Practice Address - Street 2:
Practice Address - City:ANACONDA
Practice Address - State:MT
Practice Address - Zip Code:59711-2205
Practice Address - Country:US
Practice Address - Phone:406-563-5141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT539152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT482560Medicaid
MT2893Medicare ID - Type Unspecified
MTT89296Medicare UPIN