Provider Demographics
NPI:1508998535
Name:PARDEE, THOMAS B (OD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:B
Last Name:PARDEE
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 1:4091 RICHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48506-2033
Mailing Address - Country:US
Mailing Address - Phone:810-736-0710
Mailing Address - Fax:810-736-2713
Practice Address - Street 1:4091 RICHFIELD RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48506-2033
Practice Address - Country:US
Practice Address - Phone:810-736-0710
Practice Address - Fax:810-736-2713
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002600152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900B565730OtherBCBS MI
MIT32801Medicare UPIN
MI0349600001Medicare NSC
MI900B565730OtherBCBS MI