Provider Demographics
NPI:1043348394
Name:CALLAN, THOMAS M (OD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:CALLAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:675 YGNACIO VALLEY RD
Mailing Address - Street 2:SUITE B103
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-3860
Mailing Address - Country:US
Mailing Address - Phone:925-933-0270
Mailing Address - Fax:925-933-4721
Practice Address - Street 1:675 YGNACIO VALLEY RD
Practice Address - Street 2:SUITE B103
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-3860
Practice Address - Country:US
Practice Address - Phone:925-933-0270
Practice Address - Fax:925-933-4721
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 7749 TPG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0077490Medicare ID - Type Unspecified
CAT90116Medicare UPIN