Provider Demographics
NPI:1013971282
Name:THOMAS, DANIEL EUGENE (OD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:EUGENE
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 1:2050 S WOODLANDS VILLAGE BLVD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-2971
Mailing Address - Country:US
Mailing Address - Phone:928-226-9300
Mailing Address - Fax:928-226-8651
Practice Address - Street 1:2050 S WOODLANDS VILLAGE BLVD
Practice Address - Street 2:SUITE #3
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-2971
Practice Address - Country:US
Practice Address - Phone:928-226-9300
Practice Address - Fax:928-226-8651
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1203152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU61402Medicare UPIN
AZZ163767Medicare PIN