Provider Demographics
NPI:1396903076
Name:THOMAS W MEADE OD LLC
Entity type:Organization
Organization Name:THOMAS W MEADE OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:K
Authorized Official - Last Name:MEADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-435-3601
Mailing Address - Street 1:314 W LYTLE ST
Mailing Address - Street 2:
Mailing Address - City:FOSTORIA
Mailing Address - State:OH
Mailing Address - Zip Code:44830-2432
Mailing Address - Country:US
Mailing Address - Phone:419-435-3601
Mailing Address - Fax:419-435-4295
Practice Address - Street 1:314 W LYTLE ST
Practice Address - Street 2:
Practice Address - City:FOSTORIA
Practice Address - State:OH
Practice Address - Zip Code:44830-2432
Practice Address - Country:US
Practice Address - Phone:419-435-3601
Practice Address - Fax:419-435-4295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4955 T1825332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
3963620001Medicare NSC