Provider Demographics
NPI:1083743983
Name:THOMAS BLUE EYECARE PLLC
Entity Type:Organization
Organization Name:THOMAS BLUE EYECARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:BLUE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:405-677-8831
Mailing Address - Street 1:5113 SE 15TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:DEL CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73115-3952
Mailing Address - Country:US
Mailing Address - Phone:405-677-8831
Mailing Address - Fax:405-677-8865
Practice Address - Street 1:5113 SE 15TH ST
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-3952
Practice Address - Country:US
Practice Address - Phone:405-677-8831
Practice Address - Fax:405-677-8865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200077190AMedicaid
OK300522223Medicare PIN