Provider Demographics
NPI:1083853337
Name:THOMASON, MICAH J (OD)
Entity Type:Individual
Prefix:DR
First Name:MICAH
Middle Name:J
Last Name:THOMASON
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:1127 S GUTENSOHN RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-5228
Mailing Address - Country:US
Mailing Address - Phone:479-750-3937
Mailing Address - Fax:479-750-3943
Practice Address - Street 1:1127 S GUTENSOHN RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-5228
Practice Address - Country:US
Practice Address - Phone:479-750-3937
Practice Address - Fax:479-750-3943
Is Sole Proprietor?:No
Enumeration Date:2009-02-10
Last Update Date:2011-04-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AR2634152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist