Provider Demographics
NPI:1679763148
Name:THOMAS M LERRO LTD
Entity type:Organization
Organization Name:THOMAS M LERRO LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:LERRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-356-6781
Mailing Address - Street 1:3475 W CHESTER PIKE
Mailing Address - Street 2:SUITE 180
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-4280
Mailing Address - Country:US
Mailing Address - Phone:610-356-6781
Mailing Address - Fax:610-356-6781
Practice Address - Street 1:3475 W CHESTER PIKE
Practice Address - Street 2:SUITE 180
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-4280
Practice Address - Country:US
Practice Address - Phone:610-356-6781
Practice Address - Fax:610-356-6781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PANA156FX1800X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0603960001OtherDME
PA0603960001Medicare NSC