Provider Demographics
NPI:1740515469
Name:DALE R. THOMAN, O.D. PLLC
Entity type:Organization
Organization Name:DALE R. THOMAN, O.D. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:406-750-5436
Mailing Address - Street 1:2901 BROOKS ST
Mailing Address - Street 2:(INSIDE LENSCRAFTERS)
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-7722
Mailing Address - Country:US
Mailing Address - Phone:406-549-9779
Mailing Address - Fax:406-549-0635
Practice Address - Street 1:2901 BROOKS ST
Practice Address - Street 2:(INSIDE LENSCRAFTERS)
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-7722
Practice Address - Country:US
Practice Address - Phone:406-549-9779
Practice Address - Fax:406-549-0635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMT775152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty