Provider Demographics
NPI:1437316544
Name:DR THOMAS B PERRY OD PC
Entity Type:Organization
Organization Name:DR THOMAS B PERRY OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:B
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:478-994-2988
Mailing Address - Street 1:105 MARTIN LUTHER KING JR DR
Mailing Address - Street 2:
Mailing Address - City:FORSYTH
Mailing Address - State:GA
Mailing Address - Zip Code:31029-1698
Mailing Address - Country:US
Mailing Address - Phone:478-994-2988
Mailing Address - Fax:
Practice Address - Street 1:105 MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:FORSYTH
Practice Address - State:GA
Practice Address - Zip Code:31029-1698
Practice Address - Country:US
Practice Address - Phone:478-994-2988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-18
Last Update Date:2008-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT000745332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
U20526Medicare UPIN
GA0595820001Medicare NSC