Provider Demographics
NPI:1891717880
Name:SCRUGGS, THOMAS R (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:R
Last Name:SCRUGGS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:40680 CALIFORNIA OAKS RD
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-5755
Mailing Address - Country:US
Mailing Address - Phone:951-600-1114
Mailing Address - Fax:951-600-1242
Practice Address - Street 1:40680 CALIFORNIA OAKS RD
Practice Address - Street 2:SUITE 1A
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5755
Practice Address - Country:US
Practice Address - Phone:951-600-1114
Practice Address - Fax:951-600-1242
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CASD0063440T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0063440Medicaid
CASD0063442Medicare ID - Type Unspecified
CASD0063440Medicaid