Provider Demographics
NPI:1508966805
Name:DETERMAN, THOMAS FRANCIS
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:FRANCIS
Last Name:DETERMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:TOM
Other - Middle Name:
Other - Last Name:DETERMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:2750 S PACIFIC AVE
Mailing Address - Street 2:STE D
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-3547
Mailing Address - Country:US
Mailing Address - Phone:928-782-7557
Mailing Address - Fax:928-783-8445
Practice Address - Street 1:2750 S PACIFIC AVE
Practice Address - Street 2:SUITE D
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-3555
Practice Address - Country:US
Practice Address - Phone:928-782-7557
Practice Address - Fax:928-783-8445
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOD 786152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ410030328OtherRAILROAD
AZAZ0249670OtherBCBS ARIZONA
AZ131533001OtherDMERC
AZ131533001OtherDMERC