Provider Demographics
NPI:1780068726
Name:THAMSOPIT, TOM (OD)
Entity type:Individual
Prefix:DR
First Name:TOM
Middle Name:
Last Name:THAMSOPIT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43767 15TH ST W
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-4754
Mailing Address - Country:US
Mailing Address - Phone:661-524-0085
Mailing Address - Fax:661-726-2898
Practice Address - Street 1:43767 15TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4754
Practice Address - Country:US
Practice Address - Phone:661-524-0085
Practice Address - Fax:661-726-2898
Is Sole Proprietor?:No
Enumeration Date:2015-07-18
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15377152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist