Provider Demographics
NPI:1932299963
Name:BLACKMAN, THOMAS GIBSON (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GIBSON
Last Name:BLACKMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 N SPENCE AVE
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-4318
Mailing Address - Country:US
Mailing Address - Phone:919-778-2015
Mailing Address - Fax:919-778-4808
Practice Address - Street 1:208 N SPENCE AVE
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-4318
Practice Address - Country:US
Practice Address - Phone:919-778-2015
Practice Address - Fax:919-778-4808
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC561825115152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790907AMedicaid
NC790907AMedicaid