Provider Demographics
NPI:1972655264
Name:THOMASON, TOM SKI (OD)
Entity Type:Individual
Prefix:DR
First Name:TOM
Middle Name:SKI
Last Name:THOMASON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:505 SW MILLVIEW WAY
Mailing Address - Street 2:# 100
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1291
Mailing Address - Country:US
Mailing Address - Phone:541-317-9310
Mailing Address - Fax:541-317-1202
Practice Address - Street 1:505 SW MILLVIEW WAY
Practice Address - Street 2:# 100
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1291
Practice Address - Country:US
Practice Address - Phone:541-317-9310
Practice Address - Fax:541-317-1202
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2547T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORU75317Medicare UPIN