Provider Demographics
NPI:1447312061
Name:MCINNES, THOMAS K (OD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:K
Last Name:MCINNES
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 1:13623 A-B GEORGIA AVE.
Mailing Address - Street 2:UNIT 18
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906
Mailing Address - Country:US
Mailing Address - Phone:301-933-6616
Mailing Address - Fax:301-933-5960
Practice Address - Street 1:13623 A-B GEORGIA AVE.
Practice Address - Street 2:UNIT 18
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906
Practice Address - Country:US
Practice Address - Phone:301-933-6616
Practice Address - Fax:301-933-5960
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1284152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
(PTAN) 234645Medicare PIN