Provider Demographics
NPI:1649257437
Name:SCARAMUZZA, THOMAS M (OD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:SCARAMUZZA
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:8170 33RD AVE S # MS 21110Q
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3900 PARK NICOLLET BLVD
Practice Address - Street 2:PARK NICOLLET CLINIC - SLP
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416
Practice Address - Country:US
Practice Address - Phone:952-993-3150
Practice Address - Fax:952-993-3611
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2021-03-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN2469152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNT49078Medicare UPIN