Provider Demographics
NPI:1134111297
Name:THOMAS, GILL P (OD)
Entity Type:Individual
Prefix:
First Name:GILL
Middle Name:P
Last Name:THOMAS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 E CAROLINA AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:SC
Mailing Address - Zip Code:29325-2523
Mailing Address - Country:US
Mailing Address - Phone:864-833-5355
Mailing Address - Fax:864-833-7692
Practice Address - Street 1:204 E CAROLINA AVE
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325-2523
Practice Address - Country:US
Practice Address - Phone:864-833-5355
Practice Address - Fax:864-833-7692
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDO7366152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0646670001OtherDMERC
SCDO7366Medicaid
SCT246860281Medicare PIN
SCDO7366Medicaid