Provider Demographics
NPI:1396896304
Name:THOMPSON, TRENT P (OD)
Entity type:Individual
Prefix:DR
First Name:TRENT
Middle Name:P
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 AARON DR
Mailing Address - Street 2:P.O. BOX 610
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4678
Mailing Address - Country:US
Mailing Address - Phone:509-943-3171
Mailing Address - Fax:
Practice Address - Street 1:1321 AARON DRIVE
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352
Practice Address - Country:US
Practice Address - Phone:509-943-3171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3735152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
410048751OtherRAILROAD MEDICARE
11102OtherGROUP HEALTH
3163THOtherBLUE CROSS BLUE SHIELD
WA0162496OtherWA LABOR AND INDUSTRY
11102OtherGROUP HEALTH
3163THOtherBLUE CROSS BLUE SHIELD
WAAB32911Medicare ID - Type Unspecified