Active NPI
Thomas B Souders, M.D.
- Ophthalmology Physician
- Wyomissing, PA
National Provider Identifier
1790776847
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- MD029541L
- Practice address
- 1802 Papermill Rd
Wyomissing, PA 19610-1100 - Phone
- (610) 372-0712
- Fax
- (610) 376-6968
- NPI assigned
- Oct 28, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | MD029541L | PA | Primary |
Addresses
Primary practice location
1802 Papermill Rd
Wyomissing, PA 19610-1100
Mailing address
1802 Papermill Rd
Wyomissing, PA 19610-1100
Phone (610) 372-0712
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0006827150001 | Medicaid | PA | |
| 018743 | Other | PA | HIGHMARK BLUE SHIELD |
| 0019735000 | Other | PA | KEYSTONE HEALTH EAST |
| 01389702 | Other | PA | CAPITAL BLUE CROSS |
| 4338991 | Other | PA | AETNA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD029541L | PA | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130457600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1790776847",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1802 PAPERMILL RD",
"city": "WYOMISSING",
"state": "PA",
"postal_code": "196101100",
"telephone_number": "610-372-0712",
"fax_number": "610-376-6968"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1802 PAPERMILL RD",
"city": "WYOMISSING",
"state": "PA",
"postal_code": "196101100",
"telephone_number": "610-372-0712",
"fax_number": "610-376-6968"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOUDERS",
"first_name": "THOMAS",
"middle_name": "B",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "PA",
"license": "MD029541L",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0006827150001",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HIGHMARK BLUE SHIELD",
"identifier": "018743",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KEYSTONE HEALTH EAST",
"identifier": "0019735000",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAPITAL BLUE CROSS",
"identifier": "01389702",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4338991",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wyomissing, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.