Provider Demographics
NPI:1962586040
Name:MEADE, THOMAS WESLEY (OD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WESLEY
Last Name:MEADE
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 1:2628 S TOWNSHIP ROAD 1195
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-7703
Mailing Address - Country:US
Mailing Address - Phone:419-448-9344
Mailing Address - Fax:
Practice Address - Street 1:1114 E STATE ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-4358
Practice Address - Country:US
Practice Address - Phone:419-334-2646
Practice Address - Fax:419-334-9084
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4955152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2433843Medicaid
OH4033211Medicare ID - Type UnspecifiedFOSTORIA, 314 WEST LYTLE
OHU72604Medicare UPIN
OH2433843Medicaid