Provider Demographics
NPI:1639117625
Name:SAMSON, THOMAS J (OD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:SAMSON
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 1:200 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-5675
Mailing Address - Country:US
Mailing Address - Phone:701-222-3937
Mailing Address - Fax:701-222-8805
Practice Address - Street 1:3119 N 14TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0664
Practice Address - Country:US
Practice Address - Phone:701-222-1393
Practice Address - Fax:701-222-8805
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND471152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1455123Medicaid
ND0471OtherEYEMED
51725OtherSIOUX VALLEY HEALTH PLAN
22-03332OtherMEDICA - MAIN & RUGBY
410028886OtherRAILROAD MEDICARE ID
MT484263Medicaid
61503OtherCOAST TO COAST
SD9201420Medicaid
ND60478Medicaid
ND200OtherVISION BENEFIT OF AMERICA
892835OtherNDVSI - BISMARCK
22-03340OtherMEDICA - NORTH CLINIC
ND23636OtherBCBS - BISMARCK CLINIC
488240741007OtherPREFERRED ONE
800471OtherNDVSI - RUGBY
ND200OtherVISION BENEFIT OF AMERICA
488240741007OtherPREFERRED ONE