Provider Demographics
NPI:1063614311
Name:THOMAS, PETER ANDRE (OD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:ANDRE
Last Name:THOMAS
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 1:4700 S FLAMINGO RD
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33330-2300
Mailing Address - Country:US
Mailing Address - Phone:954-252-9191
Mailing Address - Fax:
Practice Address - Street 1:4700 S FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33330-2300
Practice Address - Country:US
Practice Address - Phone:954-252-9191
Practice Address - Fax:954-680-7842
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3666152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPR#0003651OtherFLORIDA PRESCRIBER #