Provider Demographics
NPI:1326208489
Name:THOMAS R DOUD OD PC
Entity Type:Organization
Organization Name:THOMAS R DOUD OD PC
Other - Org Name:HARTLAND EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:RALPH
Authorized Official - Last Name:DOUD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:810-632-5240
Mailing Address - Street 1:11200 HIGHLAND ROAD
Mailing Address - Street 2:SUITE 501
Mailing Address - City:HARTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48353
Mailing Address - Country:US
Mailing Address - Phone:810-632-5240
Mailing Address - Fax:810-632-2048
Practice Address - Street 1:11200 HIGHLAND ROAD
Practice Address - Street 2:SUITE 501
Practice Address - City:HARTLAND
Practice Address - State:MI
Practice Address - Zip Code:48353
Practice Address - Country:US
Practice Address - Phone:810-632-5240
Practice Address - Fax:810-632-2048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003117152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU17575Medicare UPIN
MI0D76550Medicare PIN