Provider Demographics
NPI:1225861511
Name:THOMAS, NICHOLAS OWEN (OD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:OWEN
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 1:7 CLAYTON CT
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19809-3303
Mailing Address - Country:US
Mailing Address - Phone:814-691-8995
Mailing Address - Fax:
Practice Address - Street 1:116 FOXHUNT DR # 118
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-2535
Practice Address - Country:US
Practice Address - Phone:302-239-1933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEI4-0010136152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist