Provider Demographics
NPI:1063483634
Name:THOMSEN, THOMAS L (OD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:L
Last Name:THOMSEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 W 5TH ST
Mailing Address - Street 2:PO BOX 249
Mailing Address - City:ATLANTIC
Mailing Address - State:IA
Mailing Address - Zip Code:50022-1244
Mailing Address - Country:US
Mailing Address - Phone:712-243-1965
Mailing Address - Fax:712-243-1966
Practice Address - Street 1:4 W 5TH ST
Practice Address - Street 2:
Practice Address - City:ATLANTIC
Practice Address - State:IA
Practice Address - Zip Code:50022-1244
Practice Address - Country:US
Practice Address - Phone:712-243-1965
Practice Address - Fax:712-243-1966
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02081152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2155283Medicaid
IA4155283Medicaid
20705Medicare PIN
20704Medicare PIN
410014634Medicare PIN
IA2155283Medicaid
0252060001Medicare NSC