Provider Demographics
NPI:1235650797
Name:THOMAS, JENAE VICTORIA (OD)
Entity Type:Individual
Prefix:
First Name:JENAE
Middle Name:VICTORIA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 WISPY WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27332-6431
Mailing Address - Country:US
Mailing Address - Phone:814-553-2350
Mailing Address - Fax:
Practice Address - Street 1:WOMACK ARMY MEDICAL CENTER 2817 ROCK MERRITT AVE
Practice Address - Street 2:
Practice Address - City:FORT LIBERTY
Practice Address - State:NC
Practice Address - Zip Code:28310-7394
Practice Address - Country:US
Practice Address - Phone:910-643-2247
Practice Address - Fax:910-907-8612
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-05
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC2654171000000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No171000000XOther Service ProvidersMilitary Health Care Provider