Provider Demographics
NPI:1548353238
Name:CHENEY, THOMAS C (OD)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:C
Last Name:CHENEY
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 1:831 W PALO VERDE ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-5711
Mailing Address - Country:US
Mailing Address - Phone:480-507-5090
Mailing Address - Fax:
Practice Address - Street 1:1303 S LONGMORE
Practice Address - Street 2:SUITES 2 AND 3
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-9607
Practice Address - Country:US
Practice Address - Phone:480-969-1991
Practice Address - Fax:480-833-1781
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ955152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist