Provider Demographics
NPI:1487688784
Name:THOMAS, VICKY KAY (OD)
Entity Type:Individual
Prefix:DR
First Name:VICKY
Middle Name:KAY
Last Name: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 1:5500 PRAIRIE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-8463
Mailing Address - Country:US
Mailing Address - Phone:573-514-0644
Mailing Address - Fax:
Practice Address - Street 1:1201 GRINDSTONE PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-3741
Practice Address - Country:US
Practice Address - Phone:573-815-1038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006017341152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist