Healthcare Provider Details

I. General information

NPI: 1477531317
Provider Name (Legal Business Name): MARGUERITE ELLEN BALL-THOMAS O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2005
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 STATE ROAD 436
WINTER PARK FL
32792-2244
US

IV. Provider business mailing address

1935 STATE ROAD 436
WINTER PARK FL
32792-2244
US

V. Phone/Fax

Practice location:
  • Phone: 407-671-0960
  • Fax: 407-677-6696
Mailing address:
  • Phone: 407-671-0960
  • Fax: 407-677-6696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC0002336
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPC0002336
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberOPC0002336
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: