Healthcare Provider Details

I. General information

NPI: 1598932055
Provider Name (Legal Business Name): GILL P. THOMAS, OD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 01/07/2009
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

PO BOX 1185
CLINTON SC
29325-1185
US

V. Phone/Fax

Practice location:
  • Phone: 864-833-1162
  • Fax: 864-833-7692
Mailing address:
  • Phone: 864-833-1162
  • Fax: 864-833-7692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberD07366
License Number StateSC

VIII. Authorized Official

Name: DR. GILL P THOMAS
Title or Position: OWNER/OPTOMETRIST
Credential: OD
Phone: 864-833-1162