Provider Demographics
NPI:1902893241
Name:MEHELAS, THOMAS J (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:MEHELAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4235 SECOR RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4231
Mailing Address - Country:US
Mailing Address - Phone:419-473-3561
Mailing Address - Fax:
Practice Address - Street 1:3335 MEIJER DR
Practice Address - Street 2:SUITE 300
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43617-3104
Practice Address - Country:US
Practice Address - Phone:419-841-4442
Practice Address - Fax:419-841-3337
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35047094207W00000X
MI4301052580207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0564563Medicaid
OHTO9121521OtherOH GROUP MEDICARE
MI4886624Medicaid
OHTO9121521OtherOH GROUP MEDICARE
A15754Medicare UPIN