Provider Demographics
NPI:1972584308
Name:THOMAS, RAJAN (OD)
Entity Type:Individual
Prefix:DR
First Name:RAJAN
Middle Name:
Last Name:THOMAS
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 1:2962 HEART PINE WAY
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-7639
Mailing Address - Country:US
Mailing Address - Phone:845-300-3792
Mailing Address - Fax:
Practice Address - Street 1:1342 AUBURN RD STE 112
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-1675
Practice Address - Country:US
Practice Address - Phone:770-237-8150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-11
Last Update Date:2016-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002340152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist