Provider Demographics
NPI:1093831216
Name:THOMAS J. DOYLE OD, PC
Entity Type:Organization
Organization Name:THOMAS J. DOYLE OD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:DOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:517-669-2945
Mailing Address - Street 1:13151 SCHAVEY RD
Mailing Address - Street 2:PO BOX 335
Mailing Address - City:DEWITT
Mailing Address - State:MI
Mailing Address - Zip Code:48820-9016
Mailing Address - Country:US
Mailing Address - Phone:517-669-2945
Mailing Address - Fax:517-669-9707
Practice Address - Street 1:13151 SCHAVEY RD
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:MI
Practice Address - Zip Code:48820-9016
Practice Address - Country:US
Practice Address - Phone:517-669-2945
Practice Address - Fax:517-669-9707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002644152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty