Provider Demographics
NPI:1083675599
Name:THOMAS, MICHELLE ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:ANN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 CARLISLE PIKE
Mailing Address - Street 2:HAMPDEN OPTICAL
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-7709
Mailing Address - Country:US
Mailing Address - Phone:717-761-2295
Mailing Address - Fax:717-761-8123
Practice Address - Street 1:4900 CARLISLE PIKE
Practice Address - Street 2:HAMPDEN OPTICAL
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-7709
Practice Address - Country:US
Practice Address - Phone:717-761-2295
Practice Address - Fax:717-761-8123
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOET008738152W00000X
PAOB008455152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5252535OtherAETNA PIN
PA397213OtherNATL VISION ADMIN PIN
PAU35719Medicare UPIN
PA397213OtherNATL VISION ADMIN PIN