Provider Demographics
NPI:1730349226
Name:THOMAS OPTICAL
Entity type:Organization
Organization Name:THOMAS OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SEC/TREAS
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:F
Authorized Official - Last Name:BOURDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-755-2291
Mailing Address - Street 1:3375 MCCRACKEN ST
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-3670
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3375 MCCRACKEN ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-3670
Practice Address - Country:US
Practice Address - Phone:231-755-2291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
900F165060OtherBLUE CROSS BLUE SHIELD
900F165060OtherBLUE CROSS BLUE SHIELD