Provider Demographics
NPI:1013057082
Name:CORWIN, THOMAS R (OD,PHD,FAAO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:R
Last Name:CORWIN
Suffix:
Gender:M
Credentials:OD,PHD,FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 SUNSET RD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1023
Mailing Address - Country:US
Mailing Address - Phone:617-876-5252
Mailing Address - Fax:
Practice Address - Street 1:101 MIDDLESEX TPKE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4914
Practice Address - Country:US
Practice Address - Phone:781-270-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3806152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist