Provider Demographics
NPI:1386690048
Name:THOMAS, GORDON (OD)
Entity Type:Individual
Prefix:MR
First Name:GORDON
Middle Name:
Last Name:THOMAS
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 1:8319 EMBASSY BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668
Mailing Address - Country:US
Mailing Address - Phone:727-819-0440
Mailing Address - Fax:727-819-9795
Practice Address - Street 1:8319 EMBASSY BLVD
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668
Practice Address - Country:US
Practice Address - Phone:727-819-0440
Practice Address - Fax:727-819-9795
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP0002130152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
33801OtherBCBS GROUP
FL1518098102OtherMEDICARE GROUP NPI
FL1386690048OtherMEDICARE NPI
19050OtherBCBS INDIVIDUAL
ECPA-EYE MEDOtherFL2130
FL620437600OtherMEDICAID GROUP
FL19050XOtherMEDICARE PTAN
FL001656500OtherMEDICAID INDIVIDUAL
FL1386690048OtherMEDICARE NPI