Provider Demographics
NPI:1265729495
Name:THAMES, LACEY SMITH (OD)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:SMITH
Last Name:THAMES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LACEY
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5002 GATTIS SCHOOL ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HUTTO
Mailing Address - State:TX
Mailing Address - Zip Code:78634
Mailing Address - Country:US
Mailing Address - Phone:512-243-7858
Mailing Address - Fax:512-243-7835
Practice Address - Street 1:5002 GATTIS SCHOOL ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:HUTTO
Practice Address - State:TX
Practice Address - Zip Code:78634
Practice Address - Country:US
Practice Address - Phone:512-243-7858
Practice Address - Fax:512-243-7835
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7736TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist