Provider Demographics
NPI:1578555389
Name:MUNGER, THOMAS R (OD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:R
Last Name:MUNGER
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 1:202 S 6TH ST
Mailing Address - Street 2:PO BOX 517
Mailing Address - City:SAC CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50583-2242
Mailing Address - Country:US
Mailing Address - Phone:712-662-7777
Mailing Address - Fax:712-662-7311
Practice Address - Street 1:202 N 6TH ST
Practice Address - Street 2:
Practice Address - City:SAC CITY
Practice Address - State:IA
Practice Address - Zip Code:50583-1742
Practice Address - Country:US
Practice Address - Phone:712-662-7777
Practice Address - Fax:712-662-7311
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02230152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA410048396OtherRAILROAD MEDICARE
IAU91391Medicare UPIN