Provider Demographics
NPI:1740287234
Name:SHIREY, THOMASON J (OD)
Entity type:Individual
Prefix:DR
First Name:THOMASON
Middle Name:J
Last Name:SHIREY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1401 S CHERRY LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-3672
Mailing Address - Country:US
Mailing Address - Phone:817-246-3177
Mailing Address - Fax:817-246-3277
Practice Address - Street 1:1401 S CHERRY LN
Practice Address - Street 2:SUITE A
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76108-3672
Practice Address - Country:US
Practice Address - Phone:817-246-3177
Practice Address - Fax:817-246-3277
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2758152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00E94VMedicare ID - Type Unspecified
TXU43287Medicare UPIN