Healthcare Provider Details

I. General information

NPI: 1093724981
Provider Name (Legal Business Name): LISA THOMAS O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. LISA THOMAS-MATHEW

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 03/07/2023
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2802 BUSINESS CENTER DR SUITE #114
PEARLAND TX
77584-2148
US

IV. Provider business mailing address

2802 BUSINESS CENTER DR STE 114
PEARLAND TX
77584-2188
US

V. Phone/Fax

Practice location:
  • Phone: 832-228-7759
  • Fax: 281-208-0236
Mailing address:
  • Phone: 832-228-7759
  • Fax: 281-208-0236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number6801 TG
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number6801 TG
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number6801 TG
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number6801 TG
License Number StateTX
# 5
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6801 TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: