Provider Demographics
NPI:1447267224
Name:THOMAS, BYRON EUGENE (OD)
Entity type:Individual
Prefix:DR
First Name:BYRON
Middle Name:EUGENE
Last Name:THOMAS
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 1:1205 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-3560
Mailing Address - Country:US
Mailing Address - Phone:509-925-6534
Mailing Address - Fax:
Practice Address - Street 1:301 E 2ND AVE
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3315
Practice Address - Country:US
Practice Address - Phone:509-925-9873
Practice Address - Fax:509-962-1639
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD000788TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2029494Medicaid
WA2029494Medicaid
WAAB36629Medicare ID - Type Unspecified