Provider Demographics
NPI:1790787414
Name:MORLAN, THOMAS D (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:D
Last Name:MORLAN
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:PO BOX 549
Mailing Address - Street 2:835 N. CASS ST.
Mailing Address - City:WABASH
Mailing Address - State:IN
Mailing Address - Zip Code:46992-0549
Mailing Address - Country:US
Mailing Address - Phone:574-233-2160
Mailing Address - Fax:574-280-7355
Practice Address - Street 1:220 N IRONWOOD DR
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46615
Practice Address - Country:US
Practice Address - Phone:574-233-2160
Practice Address - Fax:574-280-7355
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003001A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200238080BMedicaid
IN000000637898OtherANTHEM
IN200238080BMedicaid
IN000000637898OtherANTHEM
INM400042747Medicare PIN
INM400042759Medicare PIN
IN161960AMedicare PIN
INU79908Medicare UPIN