Provider Demographics
NPI:1689644783
Name:BAUGH, THOMAS KIM (OD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:KIM
Last Name:BAUGH
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 1:307 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-3124
Mailing Address - Country:US
Mailing Address - Phone:903-465-9214
Mailing Address - Fax:903-463-6919
Practice Address - Street 1:307 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-3124
Practice Address - Country:US
Practice Address - Phone:903-465-9214
Practice Address - Fax:903-463-6919
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX03551T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019455701Medicaid
TX00E68GMedicare PIN
TXT12116Medicare UPIN