Individual
DR. ANGELA M THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
59 VETERANS MEMORIAL DR, SUITE B, KOSCIUSKO, MS 39090
(662) 289-1067
(662) 289-1058
Mailing address
PO BOX 778, KOSCIOSKO, MS 39090
(662) 289-1067
(662) 289-1058
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
562
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00087013
—
MS
01
—
P00065350
RR MEDICARE
—
Enumeration date
12/19/2006
Last updated
01/29/2008
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