Provider Demographics
NPI:1598884546
Name:PRICE, THOMAS S
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:S
Last Name:PRICE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 VINE ST
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:OH
Mailing Address - Zip Code:43138-9303
Mailing Address - Country:US
Mailing Address - Phone:740-385-2287
Mailing Address - Fax:
Practice Address - Street 1:158 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-1387
Practice Address - Country:US
Practice Address - Phone:740-385-4006
Practice Address - Fax:740-385-4043
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2692152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7076980Medicaid
OH7076980Medicaid
OHPRO157481Medicare ID - Type Unspecified