Provider Demographics
NPI:1013173186
Name:THOMAS J. OVERBERG, O.D., INC.
Entity Type:Organization
Organization Name:THOMAS J. OVERBERG, O.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:OVERBERG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:419-334-2646
Mailing Address - Street 1:PO BOX 1227
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-8227
Mailing Address - Country:US
Mailing Address - Phone:416-334-2646
Mailing Address - Fax:419-334-9084
Practice Address - Street 1:1114 E STATE ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-4358
Practice Address - Country:US
Practice Address - Phone:419-334-2646
Practice Address - Fax:419-334-9084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3431332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0635850001Medicare NSC