Provider Demographics
NPI:1255419966
Name:THOMAS H. HANDEL OD, INC.
Entity type:Organization
Organization Name:THOMAS H. HANDEL OD, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:HEINZ
Authorized Official - Last Name:HANDEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:330-666-1766
Mailing Address - Street 1:270 S CLEVELAND MASSILLON RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3014
Mailing Address - Country:US
Mailing Address - Phone:330-666-1766
Mailing Address - Fax:330-670-9662
Practice Address - Street 1:270 S CLEVELAND MASSILLON RD
Practice Address - Street 2:SUITE A
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3014
Practice Address - Country:US
Practice Address - Phone:330-666-1766
Practice Address - Fax:330-670-9662
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THOMAS H. HANDEL OD, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-01
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3945/T474152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000387842OtherANTHEM BCBS
OHDP4279OtherRAILROAD MEDICARE
OH256763Medicaid
OHDP4279OtherRAILROAD MEDICARE
OH256763Medicaid