MEDICARE: DR. THOMAS FRANCIS DETERMAN

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	152W00000X	Optometrist	OD 786	AZ
2	152WC0802X	Corneal and Contact Management Optometrist	OD 786	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	410030328	OTHER	AZ	RAILROAD
2	AZ0249670	OTHER	AZ	BCBS ARIZONA
3	131533001	OTHER	AZ	DMERC

General Provider Information

NPI Number	:	1508966805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS FRANCIS DETERMAN

Provider Business Mailing Address
First Line	:	2750 S PACIFIC AVE
Second Line	:	STE D
City	:	YUMA
State	:	AZ
Zip	:	85365-3547
Country	:	US
Telephone Number	:	928-782-7557
Fax Number	:	928-783-8445

Provider Business Practice Location Address
First Line	:	2750 S PACIFIC AVE
Second Line	:	SUITE D
City	:	YUMA
State	:	AZ
Zip	:	85365-3555
Country	:	US
Telephone Number	:	928-782-7557
Fax Number	:	928-783-8445

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

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	01/12/2022

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