Provider Demographics
NPI:1689691180
Name:BLACK, THOMAS C (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:C
Last Name:BLACK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1010 CARONDELET DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4821
Mailing Address - Country:US
Mailing Address - Phone:816-942-8008
Mailing Address - Fax:816-942-5314
Practice Address - Street 1:1010 CARONDELET DR
Practice Address - Street 2:SUITE 103
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4821
Practice Address - Country:US
Practice Address - Phone:816-942-8008
Practice Address - Fax:816-942-5314
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR3026207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
04192051OtherBLUE CROSS BLUE SHIELD
C52212Medicare UPIN
04192051OtherBLUE CROSS BLUE SHIELD