Provider Demographics
NPI:1275661837
Name:THOMAS, MADELINE J (OD, MA)
Entity Type:Individual
Prefix:DR
First Name:MADELINE
Middle Name:J
Last Name:THOMAS
Suffix:
Gender:F
Credentials:OD, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3834 TAYLORSVILLE RD # A2
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-1302
Mailing Address - Country:US
Mailing Address - Phone:502-473-8600
Mailing Address - Fax:502-473-8600
Practice Address - Street 1:3834 TAYLORSVILLE RD # A2
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-1302
Practice Address - Country:US
Practice Address - Phone:502-473-8600
Practice Address - Fax:502-473-8600
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1228DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist