Provider Demographics
NPI:1891834404
Name:ROBERT M THOMAS JR MD A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ROBERT M THOMAS JR MD A MEDICAL CORPORATION
Other - Org Name:SAN DIEGO EYE INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:619-298-1000
Mailing Address - Street 1:3900 5TH AVE
Mailing Address - Street 2:SUITE 270
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3121
Mailing Address - Country:US
Mailing Address - Phone:619-298-1000
Mailing Address - Fax:619-298-4619
Practice Address - Street 1:3900 5TH AVE
Practice Address - Street 2:SUITE 270
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3121
Practice Address - Country:US
Practice Address - Phone:619-298-1000
Practice Address - Fax:619-298-4619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC31483207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C314830Medicaid
CAA34585Medicare UPIN
CA00C314830Medicaid
CAC31483Medicare ID - Type UnspecifiedMEDICARE