Provider Demographics
NPI:1205953312
Name:AYRES, THOMAS H (O D)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:H
Last Name:AYRES
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 90713
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-9089
Mailing Address - Country:US
Mailing Address - Phone:210-340-5822
Mailing Address - Fax:210-340-3841
Practice Address - Street 1:4501 MCCULLOUGH AVE
Practice Address - Street 2:SUITE #101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-1619
Practice Address - Country:US
Practice Address - Phone:210-340-5822
Practice Address - Fax:210-340-3841
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1898152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1225350754Medicare UPIN
TX0A6048Medicare PIN