Healthcare Provider Details

I. General information

NPI: 1881874667
Provider Name (Legal Business Name): THOMAS EYE CARE S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 30TH AVE
KENOSHA WI
53144-1411
US

IV. Provider business mailing address

2305 30TH AVE
KENOSHA WI
53144-1411
US

V. Phone/Fax

Practice location:
  • Phone: 262-597-2020
  • Fax: 262-597-5452
Mailing address:
  • Phone: 262-597-2020
  • Fax: 262-597-5452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2152-035
License Number StateWI

VIII. Authorized Official

Name: DR. JEFFREY R THOMAS
Title or Position: DOCTOR/OWNER
Credential: OD
Phone: 262-597-2020