Provider Demographics
NPI:1477531317
Name:BALL-THOMAS, MARGUERITE ELLEN (OD)
Entity Type:Individual
Prefix:DR
First Name:MARGUERITE
Middle Name:ELLEN
Last Name:BALL-THOMAS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1935 STATE ROAD 436
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-2244
Mailing Address - Country:US
Mailing Address - Phone:407-671-0960
Mailing Address - Fax:407-677-6696
Practice Address - Street 1:1935 STATE ROAD 436
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-2244
Practice Address - Country:US
Practice Address - Phone:407-671-0960
Practice Address - Fax:407-677-6696
Is Sole Proprietor?:No
Enumeration Date:2005-12-31
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC0002336152WC0802X, 152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLUNITED HEALTH CAREOther201602
FL0625244OtherAETNA HMO
FL084796800Medicaid
FLA005OtherCHAMPUS
FL4401350OtherAETNA PPO
FL0912730001OtherPALMETTO (DMERC)
FLUNITED HEALTH CAREOther201602
FLA005OtherCHAMPUS