Basic Information
| Provider Information | |||||||||
| NPI: | 1881874667 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THOMAS EYE CARE S.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2305 30TH AVE | ||||||||
| Address2: | |||||||||
| City: | KENOSHA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531441411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2625972020 | ||||||||
| FaxNumber: | 2625975452 | ||||||||
| Practice Location | |||||||||
| Address1: | 2305 30TH AVE | ||||||||
| Address2: | |||||||||
| City: | KENOSHA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531441411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2625972020 | ||||||||
| FaxNumber: | 2625975452 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2007 | ||||||||
| LastUpdateDate: | 11/08/2007 | ||||||||
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| AuthorizedOfficialLastName: | THOMAS | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | DOCTOR/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2625972020 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 2152-035 | WI | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.