Provider Demographics
NPI:1033178900
Name:HEYNE-THOMPSON, PAMELA J (OD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:J
Last Name:HEYNE-THOMPSON
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 1:1231 N STATE ROAD 39
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-2042
Mailing Address - Country:US
Mailing Address - Phone:219-326-7681
Mailing Address - Fax:219-326-7681
Practice Address - Street 1:1231 N STATE ROAD 39
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-2042
Practice Address - Country:US
Practice Address - Phone:219-326-7681
Practice Address - Fax:219-326-7681
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002633152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN247510AOtherPTAN
IN247510AMedicare PIN
IN247510AOtherPTAN
INU44059Medicare UPIN