Provider Demographics
NPI:1962534990
Name:THOMAS B PARDEE
Entity type:Organization
Organization Name:THOMAS B PARDEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:B
Authorized Official - Last Name:PARDEE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:810-736-0710
Mailing Address - Street 1:4091 RICHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48506-2033
Mailing Address - Country:US
Mailing Address - Phone:810-736-0710
Mailing Address - Fax:810-736-2713
Practice Address - Street 1:4091 RICHFIELD RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48506-2033
Practice Address - Country:US
Practice Address - Phone:810-736-0710
Practice Address - Fax:810-736-2713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002600152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900B565730OtherBCBS OF MI
MIT32801Medicare UPIN
MI0B56573Medicare PIN
MI0349600001Medicare NSC