Provider Demographics
NPI:1972825412
Name:THOMAS DEAN BLUE
Entity Type:Organization
Organization Name:THOMAS DEAN BLUE
Other - Org Name:THOMAS BLUE, O.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:BLUE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:405-677-8831
Mailing Address - Street 1:5113 A S.E 15TH ST.
Mailing Address - Street 2:
Mailing Address - City:DEL CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73115
Mailing Address - Country:US
Mailing Address - Phone:405-677-8831
Mailing Address - Fax:405-677-8865
Practice Address - Street 1:5113 A S.E 15TH ST.
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115
Practice Address - Country:US
Practice Address - Phone:405-677-8831
Practice Address - Fax:405-677-8865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-25
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DS4938OtherRAILROAD MEDICARE
OK100765960AMedicaid
OK200077190AMedicaid
540012140OtherRAILROAD MEDICARE
540012140OtherRAILROAD MEDICARE
OK100765960AMedicaid