Provider Demographics
NPI:1033138631
Name:THOMPSON, LARRY D (OD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:D
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 1:4750 N DIVISION ST
Mailing Address - Street 2:STE. 205
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-1402
Mailing Address - Country:US
Mailing Address - Phone:509-482-3100
Mailing Address - Fax:509-482-0680
Practice Address - Street 1:4750 N DIVISION ST
Practice Address - Street 2:STE. 205
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1402
Practice Address - Country:US
Practice Address - Phone:509-482-3100
Practice Address - Fax:509-482-0680
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1775152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist