Provider Demographics
NPI:1356370654
Name:GEURKINK, THOMAS ADAM (OD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ADAM
Last Name:GEURKINK
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 1:1141 36TH AVE. N.W. #102
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072
Mailing Address - Country:US
Mailing Address - Phone:405-329-8100
Mailing Address - Fax:
Practice Address - Street 1:1141 36TH AVE NW STE 102
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-4168
Practice Address - Country:US
Practice Address - Phone:405-329-8100
Practice Address - Fax:405-321-5503
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1177152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK0714030001Medicare NSC
OKT86469Medicare UPIN