Provider Demographics
NPI:1093785115
Name:GRIFFITH, THOMAS E
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:E
Last Name:GRIFFITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:WV
Mailing Address - Zip Code:25177-2821
Mailing Address - Country:US
Mailing Address - Phone:304-727-5237
Mailing Address - Fax:304-727-4051
Practice Address - Street 1:205 4TH AVE
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:WV
Practice Address - Zip Code:25177-2821
Practice Address - Country:US
Practice Address - Phone:304-727-5237
Practice Address - Fax:304-727-4051
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV608-OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0150229000Medicaid
WV9143794Medicare PIN
WVU27126Medicare UPIN
WV0363550001Medicare NSC