Provider Demographics
NPI:1306978077
Name:THOMPSON, THOMAS MARK (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:MARK
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:216 W CENTRAL BLVD
Mailing Address - Street 2:PO BOX 125
Mailing Address - City:ANADARKO
Mailing Address - State:OK
Mailing Address - Zip Code:73005-3406
Mailing Address - Country:US
Mailing Address - Phone:405-247-3391
Mailing Address - Fax:405-247-3391
Practice Address - Street 1:216 W CENTRAL BLVD
Practice Address - Street 2:
Practice Address - City:ANADARKO
Practice Address - State:OK
Practice Address - Zip Code:73005-3406
Practice Address - Country:US
Practice Address - Phone:405-247-3391
Practice Address - Fax:405-247-3391
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17807156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician