Provider Demographics
NPI:1710941844
Name:KIGGINS, THOMAS DEAN (OD)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:DEAN
Last Name:KIGGINS
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 1:615 WOODSIDE RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-3879
Mailing Address - Country:US
Mailing Address - Phone:650-364-2595
Mailing Address - Fax:650-364-2616
Practice Address - Street 1:615 WOODSIDE RD
Practice Address - Street 2:SUITE 3
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-3879
Practice Address - Country:US
Practice Address - Phone:650-364-2595
Practice Address - Fax:650-364-2616
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA480977152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT09781Medicare ID - Type Unspecified