Provider Demographics
NPI:1356130868
Name:OPTHOMASTRY, PLLC
Entity type:Organization
Organization Name:OPTHOMASTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:C
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:509-765-9681
Mailing Address - Street 1:424 W 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-1908
Mailing Address - Country:US
Mailing Address - Phone:509-765-9681
Mailing Address - Fax:509-765-4123
Practice Address - Street 1:424 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-1908
Practice Address - Country:US
Practice Address - Phone:509-765-9681
Practice Address - Fax:509-765-4123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty