Provider Demographics
NPI:1316901291
Name:THOMAS, LAURENCE CRAIG (OD)
Entity type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:CRAIG
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 1:3900 W WHEATLAND RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-3468
Mailing Address - Country:US
Mailing Address - Phone:972-780-7199
Mailing Address - Fax:972-780-9157
Practice Address - Street 1:3900 W WHEATLAND RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3468
Practice Address - Country:US
Practice Address - Phone:972-780-7199
Practice Address - Fax:972-780-9157
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3229TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112413304Medicaid
TX1548489388OtherRAILROAD - GROUP NPI#
TX1316901291OtherRAILROAD - GROUP MEMBER NPI#
TX197166501OtherMEDICAID - GROUP TPI#
TX80503QOtherBLUE CROSS & BLUE SHIELD
TXP00630765OtherRAIL ROAD -GROUP MEMBER PTAN#
TX00Y945OtherNSC -MEDICARE PTAN#
TXDN6483OtherRAILROAD - GROUP PTAN#
TX005FBOtherBCBSTX -GROUP#
TX410012674OtherRAILROAD - PROVIDER ID#
TX1548489388Medicare NSC
TX5238310001Medicare NSC