Provider Demographics
NPI:1891792347
Name:O'CONNOR, THOMAS J (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:O'CONNOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-1138
Mailing Address - Country:US
Mailing Address - Phone:215-368-1646
Mailing Address - Fax:215-368-8516
Practice Address - Street 1:1000 N BROAD ST
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-1138
Practice Address - Country:US
Practice Address - Phone:215-368-1646
Practice Address - Fax:215-368-8516
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD054333L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA783363HEYMedicare ID - Type Unspecified
PA0247180001Medicare NSC
G08353Medicare UPIN