Provider Demographics
NPI:1316164437
Name:DR. THOMAS HA PROF. CORP.
Entity type:Organization
Organization Name:DR. THOMAS HA PROF. CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:T
Authorized Official - Last Name:HA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:702-435-6527
Mailing Address - Street 1:10660 SOUTHERN HIGHLANDS PARKWAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141
Mailing Address - Country:US
Mailing Address - Phone:702-435-6527
Mailing Address - Fax:702-263-9637
Practice Address - Street 1:10660 SOUTHERN HIGHLANDS PARKWAY
Practice Address - Street 2:SUITE 101
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89141
Practice Address - Country:US
Practice Address - Phone:702-435-6527
Practice Address - Fax:702-263-9637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV459152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100509728Medicaid
NVV37587Medicare PIN
NV100509728Medicaid