Provider Demographics
NPI:1043482300
Name:THOMAS, KATHRYN A
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:A
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 E HAVENS AVE
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-4402
Mailing Address - Country:US
Mailing Address - Phone:605-996-4671
Mailing Address - Fax:605-996-4671
Practice Address - Street 1:211 E HAVENS AVE
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-4402
Practice Address - Country:US
Practice Address - Phone:605-996-4671
Practice Address - Fax:605-996-4671
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0530030001Medicare NSC