Provider Demographics
NPI:1295733095
Name:ALTMAN, THOMAS (OD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:ALTMAN
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:PO BOX 275
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07660-0275
Mailing Address - Country:US
Mailing Address - Phone:201-440-1273
Mailing Address - Fax:201-440-1274
Practice Address - Street 1:290 MAIN ST
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07660-1534
Practice Address - Country:US
Practice Address - Phone:201-440-1273
Practice Address - Fax:201-440-1274
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV003432-1152W00000X
NJ27OA00374800152W00000X
NJ27OM00013300152W00000X
NJCDS#D09092900152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0988502Medicaid
NJ0988502Medicaid
NJ0480820001Medicare NSC
521393Medicare ID - Type Unspecified