Provider Demographics
NPI:1467620872
Name:THOMAS OCULAR PROSTHETICS, INC
Entity Type:Organization
Organization Name:THOMAS OCULAR PROSTHETICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:BCO
Authorized Official - Phone:901-753-4724
Mailing Address - Street 1:1900 KIRBY PKWY
Mailing Address - Street 2:STE. 102
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3653
Mailing Address - Country:US
Mailing Address - Phone:901-753-4724
Mailing Address - Fax:901-759-5920
Practice Address - Street 1:1900 KIRBY PKWY
Practice Address - Street 2:STE. 102
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38138-3653
Practice Address - Country:US
Practice Address - Phone:901-753-4724
Practice Address - Fax:901-759-5920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3554760Medicaid
TN0165655OtherBLUE CROSS BLUE SHIELD
TN0165655OtherBLUE CROSS BLUE SHIELD