Provider Demographics
NPI:1174650048
Name:THOMPSON, DENIS N (MD)
Entity Type:Individual
Prefix:
First Name:DENIS
Middle Name:N
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 801
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-4810
Mailing Address - Country:US
Mailing Address - Phone:213-977-1184
Mailing Address - Fax:213-977-0223
Practice Address - Street 1:1245 WILSHIRE BLVD
Practice Address - Street 2:SUITE 801
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4810
Practice Address - Country:US
Practice Address - Phone:213-977-1184
Practice Address - Fax:213-977-0223
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC34106156FX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOC341060Medicaid
CAC34106OtherSTATE LICENSE NUMBER
CAOOC341060Medicaid
WC34106KMedicare PIN