Provider Demographics
NPI:1568479012
Name:WELLS, THOMAS JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOSEPH
Last Name:WELLS
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 1:205 1ST ST
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-5109
Mailing Address - Country:US
Mailing Address - Phone:315-457-7968
Mailing Address - Fax:315-457-8017
Practice Address - Street 1:205 1ST ST
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-5109
Practice Address - Country:US
Practice Address - Phone:315-457-7968
Practice Address - Fax:315-457-8017
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV 2862-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0590000001Medicare NSC
NY35391BMedicare PIN