Provider Demographics
NPI:1477697548
Name:THOMAS, SIDNEY F (OD)
Entity Type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:F
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:PO BOX 30201
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29417
Mailing Address - Country:US
Mailing Address - Phone:803-536-3755
Mailing Address - Fax:
Practice Address - Street 1:915 JOHN C CALHOUN DR
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-6763
Practice Address - Country:US
Practice Address - Phone:803-536-3755
Practice Address - Fax:803-536-2584
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC984152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDA9845Medicaid
SCDA9845Medicaid