Provider Demographics
NPI:1386895290
Name:RENE, THOMAS JAMES (OD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JAMES
Last Name:RENE
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 1:1695 43RD ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-3317
Mailing Address - Country:US
Mailing Address - Phone:701-235-3937
Mailing Address - Fax:701-491-7463
Practice Address - Street 1:1695 43RD ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3317
Practice Address - Country:US
Practice Address - Phone:701-235-3937
Practice Address - Fax:701-491-7463
Is Sole Proprietor?:No
Enumeration Date:2008-10-09
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND571152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND410037872OtherTRAVELERS MEDICARE
ND800571OtherNDVSI
ND800571OtherNDVSI
NDU70520Medicare UPIN
ND410037872OtherTRAVELERS MEDICARE