Provider Demographics
NPI:1992437503
Name:THOMAS, KOURY NICOLE (OD)
Entity type:Individual
Prefix:
First Name:KOURY
Middle Name:NICOLE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 DRUMMERS LN
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-1562
Mailing Address - Country:US
Mailing Address - Phone:267-838-2962
Mailing Address - Fax:
Practice Address - Street 1:795 E MARSHALL ST STE 103
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4400
Practice Address - Country:US
Practice Address - Phone:610-429-3004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003902152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist