Provider Demographics
NPI:1316994759
Name:THIGPEN, KATHRYN E (OD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:E
Last Name:THIGPEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 ROSA LN
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-1770
Mailing Address - Country:US
Mailing Address - Phone:256-760-7213
Mailing Address - Fax:256-760-7272
Practice Address - Street 1:201 ROSA LN
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-1770
Practice Address - Country:US
Practice Address - Phone:256-760-7213
Practice Address - Fax:256-760-7272
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALSA55TA639152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009930575Medicaid
AL631080163OtherTAX ID NUMBER
AL51517436Medicare ID - Type Unspecified
AL009930575Medicaid