Provider Demographics
NPI:1467636308
Name:THOMAS, WILLIAM B (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:B
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 1:346 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1106
Mailing Address - Country:US
Mailing Address - Phone:740-446-0152
Mailing Address - Fax:740-446-0450
Practice Address - Street 1:346 3RD AVE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1106
Practice Address - Country:US
Practice Address - Phone:740-446-0152
Practice Address - Fax:740-446-0450
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2842T1607152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0345639Medicaid
OH0808110001OtherDMERC
OH0808110001OtherDMERC
OH0345639Medicaid