Provider Demographics
NPI:1205943867
Name:DEFIGUEIREDO, TOM (OD)
Entity type:Individual
Prefix:DR
First Name:TOM
Middle Name:
Last Name:DEFIGUEIREDO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1303 CORNWALL AVE
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4716
Mailing Address - Country:US
Mailing Address - Phone:360-647-0421
Mailing Address - Fax:360-657-5512
Practice Address - Street 1:1303 CORNWALL AVE
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4716
Practice Address - Country:US
Practice Address - Phone:360-647-0421
Practice Address - Fax:360-647-0469
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3630152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2711958Medicare UPIN