Provider Demographics
NPI:1174705115
Name:THOMPSON, JILL ELIZABETH (OD)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:ELIZABETH
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JILL
Other - Middle Name:ELIZABETH
Other - Last Name:FAULSTICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1323 BIA ROUTE 4
Mailing Address - Street 2:PO BOX 200
Mailing Address - City:FORT THOMPSON
Mailing Address - State:SD
Mailing Address - Zip Code:57339-0704
Mailing Address - Country:US
Mailing Address - Phone:605-245-1563
Mailing Address - Fax:605-245-2384
Practice Address - Street 1:1323 BIA ROUTE 4
Practice Address - Street 2:
Practice Address - City:FORT THOMPSON
Practice Address - State:SD
Practice Address - Zip Code:57339-0704
Practice Address - Country:US
Practice Address - Phone:605-245-1563
Practice Address - Fax:605-245-2384
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD648152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist