Provider Demographics
NPI:1588710388
Name:CEDARSTAFF, THOMAS H (OD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:H
Last Name:CEDARSTAFF
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 1:3737 45TH ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-3008
Mailing Address - Country:US
Mailing Address - Phone:219-924-6300
Mailing Address - Fax:
Practice Address - Street 1:3737 45TH ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-3008
Practice Address - Country:US
Practice Address - Phone:219-924-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001942152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN410022344OtherRAILROAD MEDICARE
IN625770Medicare ID - Type Unspecified
IN410022344OtherRAILROAD MEDICARE
IN251010AMedicare PIN