Provider Demographics
NPI:1487832366
Name:THOMPSON EYE CLINIC
Entity type:Organization
Organization Name:THOMPSON EYE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:478-218-0404
Mailing Address - Street 1:1601 MACON RD
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-2208
Mailing Address - Country:US
Mailing Address - Phone:478-218-0404
Mailing Address - Fax:478-218-4508
Practice Address - Street 1:1601 MACON RD
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-2208
Practice Address - Country:US
Practice Address - Phone:478-218-0404
Practice Address - Fax:478-218-4508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001181152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000804944CMedicaid
GA41ZCDZFMedicare PIN
GA4455460001Medicare NSC