Basic Information
| Provider Information | |||||||||
| NPI: | 1477531317 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BALL-THOMAS | ||||||||
| FirstName: | MARGUERITE | ||||||||
| MiddleName: | ELLEN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1935 STATE ROAD 436 | ||||||||
| Address2: | |||||||||
| City: | WINTER PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327922244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4076710960 | ||||||||
| FaxNumber: | 4076776696 | ||||||||
| Practice Location | |||||||||
| Address1: | 1935 STATE ROAD 436 | ||||||||
| Address2: | |||||||||
| City: | WINTER PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327922244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4076710960 | ||||||||
| FaxNumber: | 4076776696 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/31/2005 | ||||||||
| LastUpdateDate: | 10/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152WC0802X | OPC0002336 | FL | N | Eye and Vision Services Providers | Optometrist | Corneal and Contact Management | 152WP0200X | OPC0002336 | FL | N | Eye and Vision Services Providers | Optometrist | Pediatrics | 152W00000X | OPC0002336 | FL | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | UNITED HEALTH CARE | 01 | FL | 201602 | OTHER | 0625244 | 01 | FL | AETNA HMO | OTHER | 084796800 | 05 | FL | MEDICAID | A005 | 01 | FL | CHAMPUS | OTHER | 4401350 | 01 | FL | AETNA PPO | OTHER | 0912730001 | 01 | FL | PALMETTO (DMERC) | OTHER |