Angela M Thomas, O.D., Inc.
Organization Active NPI Optometrist · Kosciusko, MS
NPI 1114110996 · NPPES record last updated Jun 9, 2008
Key facts
- NPI
- 1114110996
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 562 (MS)
- Legal business name
- ANGELA M THOMAS, O.D., INC.
- Practice address
- 59 Veterans Memorial Dr
Kosciusko, MS 39090-3433 - Phone
- (662) 289-1067
- Fax
- (662) 289-1058
- NPI assigned
- Aug 24, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Angela M Thomas, OD
- Title
- Owner
- Phone
- (662) 289-1067
Practitioners 4
-
Tara Leanne Dew, O.D.
-
Angela M Thomas, OD
-
Kevin Kosek, M. D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20071226000127 | MS | Part B Supplier - Clinic/Group Practice | 8820188139 |
Receives reassigned benefits from 3 practitioners Practice locations: Kosciusko, MS |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 562 | MS | Yes |
Addresses
Primary practice location
59 Veterans Memorial Dr
Kosciusko, MS 39090-3433
Mailing address
PO Box 778
Kosciusko, MS 39090-0778
Phone (662) 289-1067
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00087013 | Medicaid | MS | |
| P00065350 | Other | MS | RAIL ROAD MEDICARE- |
Other providers in Kosciusko, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 9, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.