1801931647 NPI number — DAN G TOM O.D.

Table of content: DAN G TOM O.D. (NPI 1801931647)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801931647 NPI number — DAN G TOM O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOM
Provider First Name:
DAN
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TOM
Provider Other First Name:
DAN
Provider Other Middle Name:
G.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1801931647
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1520 W BAY AREA BLVD
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
FRIENDSWOOD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77546-2600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-934-1166
Provider Business Mailing Address Fax Number:
832-934-1161

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1520 W BAY AREA BLVD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
FRIENDSWOOD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77546-2600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-934-1166
Provider Business Practice Location Address Fax Number:
832-934-1161
Provider Enumeration Date:
02/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  3230TG , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 093614803 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3230TG . This is a "TEXAS OPTOMETRY LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com