Provider Demographics
NPI:1598932055
Name:GILL P. THOMAS, OD
Entity Type:Organization
Organization Name:GILL P. THOMAS, OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GILL
Authorized Official - Middle Name:P
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:864-833-1162
Mailing Address - Street 1:PO BOX 1185
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:SC
Mailing Address - Zip Code:29325-1185
Mailing Address - Country:US
Mailing Address - Phone:864-833-1162
Mailing Address - Fax:864-833-7692
Practice Address - Street 1:204 E CAROLINA AVE
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325-2523
Practice Address - Country:US
Practice Address - Phone:864-833-1162
Practice Address - Fax:864-833-7692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCD07366152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD07366Medicaid
SCT246860281Medicare PIN
SC0646670001Medicare NSC
SCD07366Medicaid