Provider Demographics
NPI:1104839026
Name:THOMPSON, PAUL JON (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JON
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:PO BOX 28340
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89126-2340
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
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV391152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100088Medicare ID - Type Unspecified
NVV03164Medicare UPIN