Provider Demographics
NPI:1093850315
Name:B. THOMPSON O.D. AND ASSOCIATES, PC
Entity Type:Organization
Organization Name:B. THOMPSON O.D. AND ASSOCIATES, PC
Other - Org Name:ATLANTA EYECARE ASSOCIATES, P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:404-237-4922
Mailing Address - Street 1:4104 LA VISTA RD.
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-5347
Mailing Address - Country:US
Mailing Address - Phone:770-493-6490
Mailing Address - Fax:770-493-7909
Practice Address - Street 1:4104 LA VISTA RD.
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-5347
Practice Address - Country:US
Practice Address - Phone:770-493-6490
Practice Address - Fax:770-493-7909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001123152W00000X
GA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty