Provider Demographics
NPI:1336137504
Name:SIDNEY F THOMAS PA
Entity Type:Organization
Organization Name:SIDNEY F THOMAS PA
Other - Org Name:EDISTO VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:III
Authorized Official - Credentials:OD
Authorized Official - Phone:803-536-3755
Mailing Address - Street 1:PO BOX 30201
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29417-0201
Mailing Address - Country:US
Mailing Address - Phone:803-536-3755
Mailing Address - Fax:803-536-2584
Practice Address - Street 1:915 JOHN C CALHOUN DR
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-6763
Practice Address - Country:US
Practice Address - Phone:803-536-3755
Practice Address - Fax:803-536-2584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD09845Medicaid
PA9704OtherGROUP
SCU656370282Medicare PIN
SCD09845Medicaid