Individual
DR. THOMAS R FAIRLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
9001 SUMMA AVE, BATON ROUGE, LA 70809-3726
(225) 761-5200
(225) 761-5618
Mailing address
9001 SUMMA AVE, BATON ROUGE, LA 70809-3726
(225) 761-5200
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1220-389T
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1693308
—
LA
Enumeration date
06/29/2006
Last updated
12/07/2007
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