Provider Demographics
NPI:1235569807
Name:THOMPSON, AMANDA MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:MARIE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:MARIE
Other - Last Name:TAWADROS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:612 HILLTOP WEST SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-6139
Mailing Address - Country:US
Mailing Address - Phone:757-491-1977
Mailing Address - Fax:757-491-1136
Practice Address - Street 1:612 HILLTOP WEST SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-6139
Practice Address - Country:US
Practice Address - Phone:757-491-1977
Practice Address - Fax:757-491-1136
Is Sole Proprietor?:No
Enumeration Date:2013-11-19
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003825A152W00000X
WA60398529152W00000X
VA0618002515152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist