Thomas Kenneth Bialecke, OD
Individual provider Active NPI Optometrist · Dixon, IL
NPI 1164539821 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1164539821
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- Practice address
- 1350 N Galena Ave
Dixon, IL 61021 - Phone
- (815) 284-3935
- Fax
- (815) 284-6094
- NPI assigned
- Aug 25, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2969 | WI | MD | Surgical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shopko Stores Operating Co. LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | IL | Yes |
Addresses
Primary practice location
1350 N Galena Ave
Dixon, IL 61021
Mailing address
4 Terrace Dr
Oregon, IL 61061-1237
Phone (815) 732-6966
Other providers in Dixon, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.