Provider Demographics
NPI:1023071362
Name:PEARSON, THOMAS (OD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:PEARSON
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 1:1360 E HERNDON AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3326
Mailing Address - Country:US
Mailing Address - Phone:559-449-5010
Mailing Address - Fax:559-449-5014
Practice Address - Street 1:1360 E HERNDON AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3326
Practice Address - Country:US
Practice Address - Phone:559-449-5010
Practice Address - Fax:559-449-5014
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8161TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0078922Medicaid
CAGSD004052Medicaid
CAGSD004051Medicaid
CAGSD004054Medicaid
CASD0081611Medicaid
CAGR0078923Medicaid
CAGSD004050Medicaid
CAGR0078920Medicaid
CAGR0078921Medicaid
CAGR0078924Medicaid
CASD0081614Medicare PIN
CASD0081611Medicaid
CAGSD004050Medicaid
CAU33791Medicare UPIN
CAGSD004052Medicaid
CAGR0078924Medicaid
CAZZZ13882ZMedicare PIN
CAGR0078922Medicaid
CAGR0078920Medicaid
CAGR0078921Medicaid
CASD0081613Medicare PIN