Provider Demographics
NPI:1356743272
Name:THOMAS, NICHOLAS (OD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:THOMAS
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 1:253 PINE AVE N BLDG B
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-4630
Mailing Address - Country:US
Mailing Address - Phone:813-915-0755
Mailing Address - Fax:813-915-0704
Practice Address - Street 1:253 PINE AVE N BLDG B
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-4630
Practice Address - Country:US
Practice Address - Phone:813-915-0755
Practice Address - Fax:813-915-0704
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-23
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4280152WV0400X
FLOPC 4280152W00000X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1528423779OtherWALESBY VISION CENTER NORTH