Provider Demographics
NPI:1285921387
Name:JAROME, THOMAS ALLEN (OD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ALLEN
Last Name:JAROME
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 1:8277 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-6255
Mailing Address - Country:US
Mailing Address - Phone:330-726-5544
Mailing Address - Fax:330-758-3874
Practice Address - Street 1:8277 MARKET ST
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-6255
Practice Address - Country:US
Practice Address - Phone:330-726-5544
Practice Address - Fax:330-758-3874
Is Sole Proprietor?:No
Enumeration Date:2011-07-09
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6044152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH191200Medicare PIN