Provider Demographics
NPI:1386642205
Name:CONNON, THOMAS R (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:R
Last Name:CONNON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:5250 FAR HILLS AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-2382
Mailing Address - Country:US
Mailing Address - Phone:937-433-2300
Mailing Address - Fax:937-433-0210
Practice Address - Street 1:5250 FAR HILLS AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-2382
Practice Address - Country:US
Practice Address - Phone:937-433-2300
Practice Address - Fax:937-433-0210
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3725/T785152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2201247OtherUNITED HEALTHCARE
OH3587AOtherDAVIS VISION
OH41104OtherCOLE VISION
OHAE19781OtherSPECTERA VISION
OH0688304Medicaid
OH000000189353OtherANTHEM BC/BS
OH311026469026OtherCARESOURCE
OH3587AOtherDAVIS VISION
OHT48191Medicare UPIN