Provider Demographics
NPI:1295709202
Name:CASEY, THOMAS T (OD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:T
Last Name:CASEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:2812 BROADMOOR DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-1369
Mailing Address - Country:US
Mailing Address - Phone:248-375-9170
Mailing Address - Fax:248-375-2892
Practice Address - Street 1:6966 CROOKS RD
Practice Address - Street 2:SUITE 26
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-1798
Practice Address - Country:US
Practice Address - Phone:248-828-7658
Practice Address - Fax:248-828-7148
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4901003047152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1734950Medicaid
MIOF365431Medicare ID - Type Unspecified
MIT33445Medicare UPIN
MION62070Medicare ID - Type Unspecified
MI1734950Medicaid