Provider Demographics
NPI:1124088067
Name:WOLF, THOMAS C (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:C
Last Name:WOLF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3431 S BOULEVARD ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5475
Mailing Address - Country:US
Mailing Address - Phone:405-562-2036
Mailing Address - Fax:405-562-2116
Practice Address - Street 1:3431 S BOULEVARD ST
Practice Address - Street 2:SUITE 106
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5475
Practice Address - Country:US
Practice Address - Phone:405-562-2036
Practice Address - Fax:405-562-2116
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK13218207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100110830BMedicaid
OKDA7066OtherMEDICARE RAILROAD
OK244234402Medicare ID - Type Unspecified
OKD35420Medicare UPIN