Provider Demographics
NPI:1871631135
Name:THOMAS, CHARMAINE (OD)
Entity Type:Individual
Prefix:DR
First Name:CHARMAINE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1396 SW 160TH AVE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33326-1965
Mailing Address - Country:US
Mailing Address - Phone:954-888-6466
Mailing Address - Fax:954-888-6681
Practice Address - Street 1:1396 SW 160TH AVE
Practice Address - Street 2:SUITE #2
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33326-1965
Practice Address - Country:US
Practice Address - Phone:954-888-6466
Practice Address - Fax:954-888-6681
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3624152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist