Organization
THOMAS OPTICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHILLIP SHANE THOMAS (OWNER/OPTICIAN)
(812) 503-5181
Entity
Organization
Contact information
Practice address
954 MARKET ST, CHARLESTOWN, IN 47111-1951
(812) 503-5181
(812) 565-2801
Mailing address
954 MARKET ST, CHARLESTOWN, IN 47111-1951
(812) 503-5181
(812) 565-2801
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
156FX1800X
Optician
—
—
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1346664745
—
IN
Enumeration date
06/07/2017
Last updated
06/07/2017
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