Provider Demographics
NPI:1326144684
Name:UNTERBRINK, THOMAS EDWARD (OD)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:EDWARD
Last Name:UNTERBRINK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 DANIELS CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24078-1370
Mailing Address - Country:US
Mailing Address - Phone:276-647-3861
Mailing Address - Fax:276-647-4217
Practice Address - Street 1:2202 DANIELS CREEK ROAD
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24078-1370
Practice Address - Country:US
Practice Address - Phone:276-647-3861
Practice Address - Fax:276-647-4217
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000365152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0808310002OtherDMEPOS
0808310002OtherDMEPOS