Provider Demographics
NPI:1649359407
Name:BYERS, THOMAS W (OD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:W
Last Name:BYERS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:11103 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-1370
Mailing Address - Country:US
Mailing Address - Phone:210-524-6803
Mailing Address - Fax:210-524-6587
Practice Address - Street 1:2825 S GLENSTONE AVE
Practice Address - Street 2:SPACE F/11
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-3732
Practice Address - Country:US
Practice Address - Phone:417-882-3053
Practice Address - Fax:417-882-3826
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOT02468152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU43217Medicare UPIN