1154639896 NPI number — THOMAS C O'NEIL M.D. INC

Table of content: (NPI 1154639896)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154639896 NPI number — THOMAS C O'NEIL M.D. INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS C O'NEIL M.D. INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TRACY EYE CARE MEDICAL CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154639896
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 986
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODBRIDGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95258-0986
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-339-9036
Provider Business Mailing Address Fax Number:
209-339-1901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
303 W EATON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRACY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95376-3418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-836-1155
Provider Business Practice Location Address Fax Number:
209-836-0478
Provider Enumeration Date:
09/15/2010

Additional Information

Authorized Official

Authorized Official Last Name:
O'NEIL
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESEIDENT OF CORPORATION
Authorized Official Telephone Number:
209-836-1155

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  A34142 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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