Basic Information
| Provider Information | |||||||||
| NPI: | 1932191327 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHEEZUM | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | R. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 549 E. BRAMBLETON AVE | ||||||||
| Address2: | JENCARE NEIGHBORHOOD MEDICAL NORFOLK, LLC | ||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7575339441 | ||||||||
| FaxNumber: | 7572827600 | ||||||||
| Practice Location | |||||||||
| Address1: | 549 E. BRAMBLETON AVE | ||||||||
| Address2: | JENCARE NEIGHBORHOOD MEDICAL NORFOLK, LLC | ||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7575339441 | ||||||||
| FaxNumber: | 7572827600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2005 | ||||||||
| LastUpdateDate: | 03/26/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 0618000025 | VA | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.