Provider Demographics
NPI:1891928404
Name:THOMAS L. WOLF O.D.
Entity Type:Organization
Organization Name:THOMAS L. WOLF O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:805-487-2511
Mailing Address - Street 1:2178 SAVIERS RD
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93033-3825
Mailing Address - Country:US
Mailing Address - Phone:805-487-2511
Mailing Address - Fax:805-487-4413
Practice Address - Street 1:2178 SAVIERS RD
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-3825
Practice Address - Country:US
Practice Address - Phone:805-487-2511
Practice Address - Fax:805-487-4413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-30
Last Update Date:2009-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 6141T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0177970001Medicare NSC