Basic Information
| Provider Information | |||||||||
| NPI: | 1942462635 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THATCHER | ||||||||
| FirstName: | PAULA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | RICHARDS | ||||||||
| OtherFirstName: | PAULA | ||||||||
| OtherMiddleName: | MARIE | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | O.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 8315 BEECHMONT AVE. | ||||||||
| Address2: | SUITE 33 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452553131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134744444 | ||||||||
| FaxNumber: | 5134747915 | ||||||||
| Practice Location | |||||||||
| Address1: | 8315 BEECHMONT AVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452556140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134744444 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2008 | ||||||||
| LastUpdateDate: | 10/09/2012 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 5890 | OH | Y | Eye and Vision Services Providers | Optometrist | 152W00000X | 1796DT | KY | N | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 200904380 | 05 | IN | MEDICAID | 4276654 | 01 | OH | PTAN / HAMILTON | OTHER | 4276655 | 01 | OH | PTAN / BEECHMONT | OTHER | 4276658 | 01 | OH | PTAN / LIBERTY TOWNSHIP | OTHER | 740716 | 01 | KY | PTAN / KENTUCKY | OTHER | 4276651 | 01 | OH | PTAN / HYDE PARK | OTHER | 4276653 | 01 | OH | PTAN / KENWOOD | OTHER | 4276652 | 01 | OH | PTAN / COLERAIN | OTHER | 4276651 | 01 | OH | PTAN / GLENWAY | OTHER | 4276656 | 01 | OH | PTAN / TRI COUNTY | OTHER | 4276657 | 01 | OH | PTAN / SYMMES | OTHER |