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General NPI Number Information
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NPI Number | 1194993527
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Entity Type | Organization
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Legal Business Name | DR THOMAS OD PA
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Dates
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Enumeration Date | 02/19/2008
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Last Update Date | 07/11/2011
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Provider Practice Location Address
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Address Line | 1396 SW 160TH AVE SUITE #2
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City | SUNRISE
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State | FL
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Zip | 33326-1965
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Country | US
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Telephone | 954-888-6466
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Fax | 954-888-6681
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Provider Business Mailing Address
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Address Line | 1396 SW 160TH AVE SUITE #2
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City | SUNRISE
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State | FL
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Zip | 33326-1965
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Country | US
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Telephone | 954-888-6466
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Fax | 954-888-6681
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Authorized Official
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Title or Position | SECRETARY
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Name | DR. CHARMAINE THOMAS
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Credential | O.D.
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Telephone | 954-888-6466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC 13656
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License Number State | FL
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