Provider Demographics
NPI:1558457853
Name:O'CONNOR, THOMAS J (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:O'CONNOR
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 1:2720 UNION RD
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14227-2212
Mailing Address - Country:US
Mailing Address - Phone:716-668-3030
Mailing Address - Fax:716-668-0705
Practice Address - Street 1:2720 UNION RD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14227-2212
Practice Address - Country:US
Practice Address - Phone:716-668-3030
Practice Address - Fax:716-668-0705
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT004971152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7211389OtherINDEPENDENT HEALTH
NY02510935Medicaid
NY00020363101OtherUNIVERA
NY000300192007OtherBCBS
NYT86331Medicare UPIN
NY02510935Medicaid