Provider Demographics
NPI:1619398799
Name:THOMAS D DENNIS OD LLC
Entity Type:Organization
Organization Name:THOMAS D DENNIS OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:DENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-942-1313
Mailing Address - Street 1:1541 E ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-6748
Mailing Address - Country:US
Mailing Address - Phone:954-942-1313
Mailing Address - Fax:954-942-0099
Practice Address - Street 1:1541 E ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-6748
Practice Address - Country:US
Practice Address - Phone:954-942-1313
Practice Address - Fax:954-942-0099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-17
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC813152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010389900Medicaid
FL1619398799Medicare PIN
FL010389900Medicaid