Basic Information
| Provider Information | |||||||||
| NPI: | 1598779209 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STANK | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 E MATTHEWS AVE | ||||||||
| Address2: | |||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724013145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709356396 | ||||||||
| FaxNumber: | 8709351469 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 E MATTHEWS AVE | ||||||||
| Address2: | |||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724013145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709356396 | ||||||||
| FaxNumber: | 8709351469 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2006 | ||||||||
| LastUpdateDate: | 10/06/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | N8184 | AR | Y | Allopathic & Osteopathic Physicians | Ophthalmology | 207WX0009X | N8184 | AR | N |
ID Information
| ID | Type | State | Issuer | Description | 203329909 | 01 | MO | MISSOURI MEDICAID | OTHER | 550247933 | 01 | AR | MEDICARE ID-TYPE UNSPECIFIED | OTHER | 120592001 | 05 | AR | MEDICAID | 180014251 | 01 | AR | RAILROAD MEDICARE | OTHER |