Provider Demographics
NPI:1164500450
Name:THOMAS, STEPHANIE W (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:W
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18660 BAGLEY RD
Mailing Address - Street 2:BUILDING 2 SUITE 300
Mailing Address - City:MIDDLEBURG HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130
Mailing Address - Country:US
Mailing Address - Phone:440-234-9200
Mailing Address - Fax:440-826-3817
Practice Address - Street 1:18660 BAGLEY RD
Practice Address - Street 2:BUILDING 2 SUITE 300
Practice Address - City:MIDDLEBURG HTS
Practice Address - State:OH
Practice Address - Zip Code:44130
Practice Address - Country:US
Practice Address - Phone:440-234-9200
Practice Address - Fax:440-826-3817
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35047102207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
142736OtherEYEMED
180026636OtherMEDICARE RR
000000131905OtherATHEM
0545221OtherADMINASTAR
OH0546556Medicaid
A80828Medicare UPIN
OH0545221Medicare ID - Type Unspecified