Provider Demographics
NPI:1760560056
Name:THOMAS, RICHARD G (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:G
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18660 BAGLEY RD STE 300B
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44130-8454
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
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.047101207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0545211OtherADMINASTAR
OH0546547Medicaid
180018575OtherMEDICARE RR
000000131904OtherANTHEM
142734OtherEYEMED
A15648Medicare UPIN
142734OtherEYEMED