Provider Demographics
NPI:1396761102
Name:THOMAS, JOSEPH M (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:M
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3619 PARK EAST DR
Mailing Address - Street 2:SUITE 306
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4330
Mailing Address - Country:US
Mailing Address - Phone:216-292-9150
Mailing Address - Fax:216-292-9159
Practice Address - Street 1:3619 PARK EAST DR
Practice Address - Street 2:SUITE 306
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4330
Practice Address - Country:US
Practice Address - Phone:216-292-9150
Practice Address - Fax:216-292-9159
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-070424207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0330412Medicaid
OH000000127585OtherANTHEM
OHG31386Medicare UPIN