Provider Demographics
NPI:1578876728
Name:THOMAS, JACK CLAYTON (OD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:CLAYTON
Last Name:THOMAS
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 1:2700 PARAMOUNT BLVD
Mailing Address - Street 2:SUITE 650
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-3009
Mailing Address - Country:US
Mailing Address - Phone:806-355-9536
Mailing Address - Fax:
Practice Address - Street 1:2700 PARAMOUNT BLVD
Practice Address - Street 2:SUITE 650
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-3009
Practice Address - Country:US
Practice Address - Phone:806-355-9536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7616TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist