Provider Demographics
NPI:1679594758
Name:DEVETSKI, THOMAS SCOTT (OD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:SCOTT
Last Name:DEVETSKI
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 1:1016 KIRKPATRICK ROAD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-9714
Mailing Address - Country:US
Mailing Address - Phone:336-228-0254
Mailing Address - Fax:336-584-0101
Practice Address - Street 1:1016 KIRKPATRICK ROAD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-9714
Practice Address - Country:US
Practice Address - Phone:336-228-0254
Practice Address - Fax:336-584-0101
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1659152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790913RMedicaid
NC2470803AMedicare PIN
NC790913RMedicaid
0366180016Medicare NSC
NC0366180001Medicare NSC