Basic Information
| Provider Information | |||||||||
| NPI: | 1093799611 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | GARRY | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6233 N UNIVERSITY DR | ||||||||
| Address2: | |||||||||
| City: | TAMARAC | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333214022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547210000 | ||||||||
| FaxNumber: | 9547216308 | ||||||||
| Practice Location | |||||||||
| Address1: | 1901 S CONGRESS AVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | BOYNTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334266556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616027773 | ||||||||
| FaxNumber: | 5613362267 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2005 | ||||||||
| LastUpdateDate: | 09/17/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | MD038774-E | PA | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | ME91656 | FL | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 1172681 | 05 | PA | MEDICAID |