Provider Demographics
NPI:1497949366
Name:THOMAS EYECARE PA
Entity Type:Organization
Organization Name:THOMAS EYECARE PA
Other - Org Name:KELLER EYE CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:817-379-6200
Mailing Address - Street 1:601 S MAIN ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-7029
Mailing Address - Country:US
Mailing Address - Phone:817-379-6200
Mailing Address - Fax:817-379-6224
Practice Address - Street 1:601 S MAIN ST
Practice Address - Street 2:SUITE 250
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-7029
Practice Address - Country:US
Practice Address - Phone:817-379-6200
Practice Address - Fax:817-379-6224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05986T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU47322Medicare UPIN
TX6242640002Medicare NSC