Provider Demographics
NPI:1053332528
Name:MAHER, THOMAS (OD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:MAHER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 MERRIAM AVE
Mailing Address - Street 2:SUITE 121
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453
Mailing Address - Country:US
Mailing Address - Phone:978-537-6045
Mailing Address - Fax:978-534-9845
Practice Address - Street 1:865 MERRIAM AVE
Practice Address - Street 2:SUITE 121
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453
Practice Address - Country:US
Practice Address - Phone:978-537-6045
Practice Address - Fax:978-534-9845
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4198152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0335321Medicaid
MA110014790AMedicaid
MA0335321Medicaid
MAW17629Medicare PIN