Provider Demographics
NPI:1265719066
Name:WALESBY VISION CENTER P A
Entity type:Organization
Organization Name:WALESBY VISION CENTER P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:813-915-0755
Mailing Address - Street 1:253 PINE AVE N UNIT B
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-4630
Mailing Address - Country:US
Mailing Address - Phone:813-915-0755
Mailing Address - Fax:813-915-0704
Practice Address - Street 1:253 PINE AVE N UNIT B
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-4630
Practice Address - Country:US
Practice Address - Phone:813-915-0755
Practice Address - Fax:813-915-0704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-08
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084909000Medicaid
FL4698530001Medicare NSC
FLFR724AMedicare PIN