Provider Demographics
NPI:1750523528
Name:THOMAS, JENNIFER VERONICA (OD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:VERONICA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2266 ARBY CT
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-3852
Mailing Address - Country:US
Mailing Address - Phone:516-308-3045
Mailing Address - Fax:
Practice Address - Street 1:2266 ARBY CT
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-3852
Practice Address - Country:US
Practice Address - Phone:516-308-3045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006800152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV05185Medicare UPIN
NYC392B81G11Medicare PIN