Provider Demographics
NPI:1063135812
Name:THOMAS, LACY N (LDO,ABOC)
Entity type:Individual
Prefix:
First Name:LACY
Middle Name:N
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LDO,ABOC
Other - Prefix:MISS
Other - First Name:LACY
Other - Middle Name:N
Other - Last Name:SOUTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LDO,ABOC
Mailing Address - Street 1:8301 ROGERS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-5236
Mailing Address - Country:US
Mailing Address - Phone:479-478-6241
Mailing Address - Fax:479-478-6753
Practice Address - Street 1:8301 ROGERS AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5236
Practice Address - Country:US
Practice Address - Phone:479-478-6241
Practice Address - Fax:479-478-6753
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL-120107156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician