Provider Demographics
NPI:1154593911
Name:THOMAS E. GRIFFITH O.D.
Entity type:Organization
Organization Name:THOMAS E. GRIFFITH O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-727-5237
Mailing Address - Street 1:205 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:WV
Mailing Address - Zip Code:25177-2821
Mailing Address - Country:US
Mailing Address - Phone:304-727-5237
Mailing Address - Fax:304-727-4051
Practice Address - Street 1:205 4TH AVE
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:WV
Practice Address - Zip Code:25177-2821
Practice Address - Country:US
Practice Address - Phone:304-727-5237
Practice Address - Fax:304-727-4051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
WV608-OD332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0363550001Medicare NSC