Provider Demographics
NPI:1639348444
Name:TOM ANNUNZIATO, O.D., P.C.
Entity Type:Organization
Organization Name:TOM ANNUNZIATO, O.D., P.C.
Other - Org Name:1ST EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:ANNUNZIATO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:817-594-2121
Mailing Address - Street 1:3608 ALTA MESA BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-5641
Mailing Address - Country:US
Mailing Address - Phone:817-346-2020
Mailing Address - Fax:817-370-1655
Practice Address - Street 1:702 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-5352
Practice Address - Country:US
Practice Address - Phone:817-594-2121
Practice Address - Fax:817-594-3825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00958NMedicare PIN
TX3951340001Medicare NSC