MEDICARE: DR. MARY JO ANN 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	152W00000X	Optometrist	OEG002181	PA

General Provider Information

NPI Number	:	1942431663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY JO ANN THOMAS O.D.

Provider Business Mailing Address
First Line	:	2900 W GERMANTOWN PIKE
Second Line	:
City	:	TROOPER
State	:	PA
Zip	:	19403-1037
Country	:	US
Telephone Number	:	610-630-6633
Fax Number	:	610-630-8239

Provider Business Practice Location Address
First Line	:	2900 W GERMANTOWN PIKE
Second Line	:
City	:	TROOPER
State	:	PA
Zip	:	19403-1037
Country	:	US
Telephone Number	:	610-630-6633
Fax Number	:	610-630-8239

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

Provider Enumeration Date	:	07/29/2009
Last Update Date	:	07/29/2009

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