Provider Demographics
NPI:1134237365
Name:ALTENBERND, THOMAS WILLIAM (OD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WILLIAM
Last Name:ALTENBERND
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:111 CLIFF CAVE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-3611
Mailing Address - Country:US
Mailing Address - Phone:314-846-8232
Mailing Address - Fax:314-845-0814
Practice Address - Street 1:111 CLIFF CAVE RD STE 100
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-3611
Practice Address - Country:US
Practice Address - Phone:314-846-8232
Practice Address - Fax:314-845-0814
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO3366152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist