Provider Demographics
NPI:1821006149
Name:SCANNELL, THOMAS J (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:SCANNELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1201 S MAIN ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-2833
Mailing Address - Country:US
Mailing Address - Phone:830-249-3898
Mailing Address - Fax:830-249-9228
Practice Address - Street 1:1201 S MAIN ST
Practice Address - Street 2:SUITE 108
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2833
Practice Address - Country:US
Practice Address - Phone:830-249-3898
Practice Address - Fax:830-249-9228
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX4032TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0933517-01Medicaid
TX0933517-01Medicaid