Healthcare Provider Details

I. General information

NPI: 1134111297
Provider Name (Legal Business Name): GILL P THOMAS OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 E CAROLINA AVE
CLINTON SC
29325-2523
US

IV. Provider business mailing address

204 E CAROLINA AVE
CLINTON SC
29325-2523
US

V. Phone/Fax

Practice location:
  • Phone: 864-833-5355
  • Fax: 864-833-7692
Mailing address:
  • Phone: 864-833-5355
  • Fax: 864-833-7692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberDO7366
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: