Provider Demographics
NPI:1598779209
Name:STANK, THOMAS M (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:STANK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 E MATTHEWS AVE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-3145
Mailing Address - Country:US
Mailing Address - Phone:870-935-6396
Mailing Address - Fax:870-935-1469
Practice Address - Street 1:601 E MATTHEWS AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3145
Practice Address - Country:US
Practice Address - Phone:870-935-6396
Practice Address - Fax:870-935-1469
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN8184207W00000X, 207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203329909OtherMISSOURI MEDICAID
AR550247933OtherMEDICARE ID-TYPE UNSPECIFIED
AR120592001Medicaid
AR180014251OtherRAILROAD MEDICARE
MO203329909OtherMISSOURI MEDICAID
AR550247933OtherMEDICARE ID-TYPE UNSPECIFIED