Provider Demographics
NPI:1245582154
Name:THOMPSON, MICHELE DESJARDINS (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:DESJARDINS
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W RIVER RD
Mailing Address - Street 2:
Mailing Address - City:RUMSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07760-1124
Mailing Address - Country:US
Mailing Address - Phone:732-345-0247
Mailing Address - Fax:
Practice Address - Street 1:4338 AMBOY RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-3820
Practice Address - Country:US
Practice Address - Phone:718-494-1319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005282152W00000X
NJ27TO00089800152W00000X
NJ27OA00541000152W00000X
NJ27OM00090800152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist