Provider Demographics
NPI:1366611105
Name:THOMAS VISION CLINIC, INC
Entity type:Organization
Organization Name:THOMAS VISION CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLIFTON
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:COWAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:337-239-2020
Mailing Address - Street 1:PO BOX 681
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71496-0681
Mailing Address - Country:US
Mailing Address - Phone:337-239-2020
Mailing Address - Fax:337-239-0755
Practice Address - Street 1:1100 N 5TH ST
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-2910
Practice Address - Country:US
Practice Address - Phone:337-239-2020
Practice Address - Fax:337-239-0755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA0633160001Medicare NSC