Provider Demographics
NPI:1477577468
Name:THOMPSON, KELLY R (OD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:R
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:119 WOODCREST DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-7753
Mailing Address - Country:US
Mailing Address - Phone:513-833-6950
Mailing Address - Fax:513-475-6944
Practice Address - Street 1:3200 VINE ST
Practice Address - Street 2:CINCINNATI VAMC - B147
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-2213
Practice Address - Country:US
Practice Address - Phone:513-861-3100
Practice Address - Fax:513-475-6944
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH5576152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist