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Individual
MR. GORDON THOMAS
Active
Individual
MR. GORDON THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OP0002130
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001656500
MEDICAID INDIVIDUAL
FL
01
—
1386690048
MEDICARE NPI
FL
01
—
1518098102
MEDICARE GROUP NPI
FL
01
—
19050
BCBS INDIVIDUAL
—
01
—
19050X
MEDICARE PTAN
FL
01
—
33801
BCBS GROUP
—
01
—
620437600
MEDICAID GROUP
FL
01
—
ECPA-EYE MED
FL2130
—
Enumeration date
05/25/2006
Last updated
06/01/2011
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