Provider Demographics
NPI:1255649240
Name:FEIDEN, THOMAS EDWARD SR (OPTALMIC DISPENSER)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:EDWARD
Last Name:FEIDEN
Suffix:SR
Gender:M
Credentials:OPTALMIC DISPENSER
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Mailing Address - Street 1:451 HOOSICK ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-2100
Mailing Address - Country:US
Mailing Address - Phone:518-274-3390
Mailing Address - Fax:518-274-3398
Practice Address - Street 1:451 HOOSICK ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2100
Practice Address - Country:US
Practice Address - Phone:518-274-3390
Practice Address - Fax:518-274-3398
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY006352-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician