Provider Demographics
NPI:1174757686
Name:THOMAS B. DANKWORTH, O.D., INC
Entity type:Organization
Organization Name:THOMAS B. DANKWORTH, O.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:B
Authorized Official - Last Name:DANKWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:513-932-5965
Mailing Address - Street 1:600 MOUND CT
Mailing Address - Street 2:PO BOX 406
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-1994
Mailing Address - Country:US
Mailing Address - Phone:513-932-5965
Mailing Address - Fax:513-932-2650
Practice Address - Street 1:600 MOUND CT
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-1994
Practice Address - Country:US
Practice Address - Phone:513-932-5965
Practice Address - Fax:513-932-2650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-12
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2906T400152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0590810001Medicare NSC