Provider Demographics
NPI:1619020609
Name:WARD, THOMAS EUGENE (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:EUGENE
Last Name:WARD
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 1:2132 EUREKA WAY
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0427
Mailing Address - Country:US
Mailing Address - Phone:530-244-4234
Mailing Address - Fax:530-244-0465
Practice Address - Street 1:2132 EUREKA WAY
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0427
Practice Address - Country:US
Practice Address - Phone:530-244-4234
Practice Address - Fax:530-244-0465
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5966T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0059660OtherBLUE SHIELD OF CALIFORNIA
CA06769OtherMEDICAL EYE SERVICES
CA116543OtherEYEMED
CASD0059660Medicaid
CA942474967OtherTAX ID
CASD0059660OtherBLUE CROSS OF CALIFORNIA
CASD0059660Medicare PIN
CA942474967OtherTAX ID
CASD0059660OtherBLUE SHIELD OF CALIFORNIA
CAT95893Medicare UPIN