Provider Demographics
NPI:1962502732
Name:SHEEHAN, THOMAS M (OD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:SHEEHAN
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 1:68 CUMBERLAND STREET
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-3323
Mailing Address - Country:US
Mailing Address - Phone:401-762-4473
Mailing Address - Fax:401-765-3261
Practice Address - Street 1:68 CUMBERLAND STREET
Practice Address - Street 2:SUITE 205
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-3323
Practice Address - Country:US
Practice Address - Phone:401-762-4473
Practice Address - Fax:401-765-3261
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTA00306152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAZB2856OtherMASSACHUSETTS BLUE CROSS
RI22-00120OtherUNITED HEALTH
RI9878-0OtherBLUECROSSBLUESHIELDRI
RI9009878Medicaid
RI9009878Medicaid