Provider Demographics
NPI:1932191327
Name:CHEEZUM, THOMAS R (OD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:R
Last Name:CHEEZUM
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:549 E. BRAMBLETON AVE
Mailing Address - Street 2:JENCARE NEIGHBORHOOD MEDICAL NORFOLK, LLC
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510
Mailing Address - Country:US
Mailing Address - Phone:757-533-9441
Mailing Address - Fax:757-282-7600
Practice Address - Street 1:549 E. BRAMBLETON AVE
Practice Address - Street 2:JENCARE NEIGHBORHOOD MEDICAL NORFOLK, LLC
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510
Practice Address - Country:US
Practice Address - Phone:757-533-9441
Practice Address - Fax:757-282-7600
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0618000025152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA410014192Medicare PIN
VAT88912Medicare UPIN
VA410000334Medicare PIN