Provider Demographics
NPI:1043349954
Name:PAUL THOMPSON OD PC
Entity Type:Organization
Organization Name:PAUL THOMPSON OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:JON
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:702-822-2202
Mailing Address - Street 1:P.O. BOX 28340
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89126
Mailing Address - Country:US
Mailing Address - Phone:702-822-2202
Mailing Address - Fax:702-822-2274
Practice Address - Street 1:4505 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1501
Practice Address - Country:US
Practice Address - Phone:702-822-2202
Practice Address - Fax:702-822-2274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV391152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV03164Medicare UPIN
100088Medicare ID - Type Unspecified