Provider Demographics
NPI:1699746719
Name:THOMSEN, LINDA S (OD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:S
Last Name:THOMSEN
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 1:807 N SUMNER AVE
Mailing Address - Street 2:PO BOX 323
Mailing Address - City:CRESTON
Mailing Address - State:IA
Mailing Address - Zip Code:50801-1350
Mailing Address - Country:US
Mailing Address - Phone:641-782-2111
Mailing Address - Fax:641-782-2113
Practice Address - Street 1:807 N SUMNER AVE
Practice Address - Street 2:BOX 323
Practice Address - City:CRESTON
Practice Address - State:IA
Practice Address - Zip Code:50801-1350
Practice Address - Country:US
Practice Address - Phone:641-782-2111
Practice Address - Fax:641-782-2113
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2021T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0101642Medicaid
IA2101642Medicaid
IAU44032Medicare UPIN
IA12999Medicare ID - Type UnspecifiedUSED IN ATLANTIC IA OFFIC
IA13000Medicare ID - Type Unspecified
IA2101642Medicaid