Provider Demographics
NPI:1164574117
Name:THOMPSON EYE CLINIC PA
Entity Type:Organization
Organization Name:THOMPSON EYE CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:913-631-7700
Mailing Address - Street 1:11005 W 60TH ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66203-2789
Mailing Address - Country:US
Mailing Address - Phone:913-631-7700
Mailing Address - Fax:913-631-8080
Practice Address - Street 1:11005 W 60TH ST
Practice Address - Street 2:SUITE 210
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66203-2789
Practice Address - Country:US
Practice Address - Phone:913-631-7700
Practice Address - Fax:913-631-8080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0429611261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS37700017OtherBLUE CROSS BLUE SHIELD
KSW790000Medicare UPIN
KS5845530001Medicare NSC