MEDICARE: WHITNEY THOMAS OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	8236T	TX

General Provider Information

NPI Number	:	1184066680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WHITNEY THOMAS OD

Provider Business Mailing Address
First Line	:	14401 JAYCEE LN
Second Line	:
City	:	HASLET
State	:	TX
Zip	:	76052-5854
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5860 N TARRANT PKWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-7201
Country	:	US
Telephone Number	:	817-805-3323
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2013
Last Update Date	:	07/24/2013

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Directions to “ WHITNEY THOMAS OD” Practice Location

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