Provider Demographics
NPI:1568436756
Name:WEBB, THOMAS PHILLIPS (OD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:PHILLIPS
Last Name:WEBB
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 1:29 OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-2460
Mailing Address - Country:US
Mailing Address - Phone:315-732-7121
Mailing Address - Fax:
Practice Address - Street 1:29 OAKWOOD DR
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-2460
Practice Address - Country:US
Practice Address - Phone:315-732-7121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0032131152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY161019707OtherEXCELLUS BCBS
161019707OtherVISION SERVICE PLAN NATIO
NY595213OtherMVP
NY00561853Medicaid
NY0216170001Medicare NSC
T26313Medicare UPIN
NY00561853Medicaid