Provider Demographics
NPI:1215070628
Name:COLEMAN, THOMAS CROSS (OD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:CROSS
Last Name:COLEMAN
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 1:4132 POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-3618
Mailing Address - Country:US
Mailing Address - Phone:901-680-0377
Mailing Address - Fax:
Practice Address - Street 1:2817 BARTLETT BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-4529
Practice Address - Country:US
Practice Address - Phone:901-371-0770
Practice Address - Fax:901-371-9892
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2257152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist