Basic Information
Provider Information
NPI: 1154639896
EntityType: 2
ReplacementNPI:  
OrganizationName: THOMAS C O'NEIL M.D. INC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: TRACY EYE CARE MEDICAL CLINIC
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 986
Address2:  
City: WOODBRIDGE
State: CA
PostalCode: 952580986
CountryCode: US
TelephoneNumber: 2093399036
FaxNumber: 2093391901
Practice Location
Address1: 303 W EATON AVE
Address2:  
City: TRACY
State: CA
PostalCode: 953763418
CountryCode: US
TelephoneNumber: 2098361155
FaxNumber: 2098360478
Other Information
ProviderEnumerationDate: 09/15/2010
LastUpdateDate: 09/15/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: O'NEIL
AuthorizedOfficialFirstName: THOMAS
AuthorizedOfficialMiddleName: C
AuthorizedOfficialTitleorPosition: PRESEIDENT OF CORPORATION
AuthorizedOfficialTelephone: 2098361155
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: M.D.
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207W00000XA34142CAY193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansOphthalmology 

No ID Information.


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