Provider Demographics
NPI:1821096587
Name:DANKWORTH, THOMAS B (OD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:B
Last Name:DANKWORTH
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 1:600 MOUND CT
Mailing Address - Street 2:PO BOX 406
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-1994
Mailing Address - Country:US
Mailing Address - Phone:513-932-5965
Mailing Address - Fax:513-932-2650
Practice Address - Street 1:600 MOUND CT
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-1994
Practice Address - Country:US
Practice Address - Phone:513-932-5965
Practice Address - Fax:513-932-2650
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2906 T400152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHT46245Medicare UPIN
OH0590810001Medicare NSC
OH0374131Medicare ID - Type Unspecified