MEDICARE: DR. MARGUERITE ELLEN BALL-THOMAS O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152WC0802X	Corneal and Contact Management Optometrist	OPC0002336	FL
2	152WP0200X	Pediatric Optometrist	OPC0002336	FL
3	152W00000X	Optometrist	OPC0002336	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	UNITED HEALTH CARE	OTHER	FL	201602
2	0625244	OTHER	FL	AETNA HMO
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	A005	OTHER	FL	CHAMPUS
5	4401350	OTHER	FL	AETNA PPO
6	0912730001	OTHER	FL	PALMETTO (DMERC)
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477531317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARGUERITE ELLEN BALL-THOMAS O.D.

Provider Business Mailing Address
First Line	:	1935 STATE ROAD 436
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-2244
Country	:	US
Telephone Number	:	407-671-0960
Fax Number	:	407-677-6696

Provider Business Practice Location Address
First Line	:	1935 STATE ROAD 436
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-2244
Country	:	US
Telephone Number	:	407-671-0960
Fax Number	:	407-677-6696

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/31/2005
Last Update Date	:	10/11/2022

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