Provider Demographics
NPI:1831278654
Name:VANDERPOOL, THOMAS EUGENE (OD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:EUGENE
Last Name:VANDERPOOL
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 1:301 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-3746
Mailing Address - Country:US
Mailing Address - Phone:918-299-2020
Mailing Address - Fax:918-298-0898
Practice Address - Street 1:301 W MAIN ST
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-3746
Practice Address - Country:US
Practice Address - Phone:918-299-2020
Practice Address - Fax:918-298-0898
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK914152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist