Provider Demographics
NPI:1275845711
Name:AUGUSTIN, THOMAS J (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:AUGUSTIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2261 4TH ST SW
Mailing Address - Street 2:SUITE B
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-4606
Mailing Address - Country:US
Mailing Address - Phone:641-201-1711
Mailing Address - Fax:641-201-1714
Practice Address - Street 1:2261 4TH ST SW
Practice Address - Street 2:SUITE B
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-4606
Practice Address - Country:US
Practice Address - Phone:641-201-1711
Practice Address - Fax:641-201-1714
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3186152W00000X
IA002521152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist