Provider Demographics
NPI:1992706675
Name:KANARD, THOMAS HAILEY (OD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:HAILEY
Last Name:KANARD
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 1:404 E WYANDOTTE AVE
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-5464
Mailing Address - Country:US
Mailing Address - Phone:918-426-0728
Mailing Address - Fax:918-426-0740
Practice Address - Street 1:404 E WYANDOTTE AVE
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5464
Practice Address - Country:US
Practice Address - Phone:918-426-0728
Practice Address - Fax:918-426-0740
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK843152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK0291000001OtherDMERC- PALMETTO
T40521Medicare UPIN