Provider Demographics
NPI:1720180961
Name:THOMAS A PERKOWSKI DO LTD
Entity Type:Organization
Organization Name:THOMAS A PERKOWSKI DO LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:PERKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-343-3213
Mailing Address - Street 1:658 BOULEVARD ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-2027
Mailing Address - Country:US
Mailing Address - Phone:330-343-3213
Mailing Address - Fax:330-364-2729
Practice Address - Street 1:658 BOULEVARD ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-2027
Practice Address - Country:US
Practice Address - Phone:330-343-3213
Practice Address - Fax:330-364-2729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.007172207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDE4442OtherTRAVELERS MEDICARE
OHTH9358561Medicare ID - Type Unspecified
OHH75011Medicare UPIN