Provider Demographics
NPI:1699711713
Name:TOM J. SHIREY, O.D., P.A.
Entity type:Organization
Organization Name:TOM J. SHIREY, O.D., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHIREY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:817-246-3177
Mailing Address - Street 1:6770 WESTWORTH BLVD.
Mailing Address - Street 2:SUITE 600
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76114
Mailing Address - Country:US
Mailing Address - Phone:817-246-3177
Mailing Address - Fax:817-246-3277
Practice Address - Street 1:6770 WESTWORTH BLVD.
Practice Address - Street 2:SUITE 600
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76114
Practice Address - Country:US
Practice Address - Phone:817-246-3177
Practice Address - Fax:817-246-3277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2758152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1740287234OtherINDIVIDUAL NPI
TXU43287Medicare UPIN
TX00E94VMedicare ID - Type UnspecifiedMEDICARE ID