Provider Demographics
NPI:1962567487
Name:THOMSON, CLIVE J (OD)
Entity type:Individual
Prefix:DR
First Name:CLIVE
Middle Name:J
Last Name:THOMSON
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 1:1804 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-5402
Mailing Address - Country:US
Mailing Address - Phone:956-687-2875
Mailing Address - Fax:956-687-3128
Practice Address - Street 1:3147 BOCA CHICA BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-3567
Practice Address - Country:US
Practice Address - Phone:956-544-2607
Practice Address - Fax:956-544-2608
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2219152W00000X
TX6663T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F21175OtherMEDICARE
TN3944381Medicaid
TX8F21175OtherMEDICARE
TN3944381Medicare ID - Type UnspecifiedOD PIN