Provider Demographics
NPI:1679651814
Name:THOMAS & THOMAS OPHTHALMOLOGY, INC
Entity Type:Organization
Organization Name:THOMAS & THOMAS OPHTHALMOLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:W
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-234-9200
Mailing Address - Street 1:4550 SLEEPY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-8334
Mailing Address - Country:US
Mailing Address - Phone:440-234-9200
Mailing Address - Fax:440-826-3817
Practice Address - Street 1:18660 BAGLEY RD STE 300B
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-8454
Practice Address - Country:US
Practice Address - Phone:440-234-9200
Practice Address - Fax:440-826-3817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CD1702OtherMEDICARE RR
OH0557624Medicaid
000000165805OtherANTHEM
OH0557624Medicaid
OH0653900001Medicare NSC
OH9918991Medicare PIN