Provider Demographics
NPI:1730237579
Name:THOMPSON, STEPHEN P (OD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:P
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2200 COOLIDGE RD
Mailing Address - Street 2:#15
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-1363
Mailing Address - Country:US
Mailing Address - Phone:517-977-1598
Mailing Address - Fax:517-977-1785
Practice Address - Street 1:2200 COOLIDGE RD
Practice Address - Street 2:#15
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-1363
Practice Address - Country:US
Practice Address - Phone:517-977-1598
Practice Address - Fax:517-977-1785
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003790152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU75008Medicare UPIN
MIN34040008Medicare ID - Type Unspecified