Provider Demographics
NPI:1043370828
Name:VAXMONSKY, THOMAS JACOB JR (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JACOB
Last Name:VAXMONSKY
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:5500 BUCKEYSTOWN PIKE STE 620
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-9458
Practice Address - Country:US
Practice Address - Phone:301-663-4745
Practice Address - Fax:301-293-0256
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMDTA0999152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD31444OtherUNITEDHEALTHCARE
VA064796Medicare ID - Type Unspecified
T49137Medicare UPIN