Provider Demographics
NPI:1467415802
Name:POLITZER, THOMAS A (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:POLITZER
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 1:332 E ASPEN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:FRUITA
Mailing Address - State:CO
Mailing Address - Zip Code:81521-2204
Mailing Address - Country:US
Mailing Address - Phone:970-858-2020
Mailing Address - Fax:970-858-6601
Practice Address - Street 1:332 E ASPEN AVE STE 100
Practice Address - Street 2:
Practice Address - City:FRUITA
Practice Address - State:CO
Practice Address - Zip Code:81521-2204
Practice Address - Country:US
Practice Address - Phone:970-858-2020
Practice Address - Fax:970-858-6601
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1105152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU12612Medicare UPIN
COC41593Medicare PIN
CO0672120001Medicare NSC