Provider Demographics
NPI:1265501431
Name:THOMPSON, KATHRYN S (OD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:S
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2701 184TH ST SW
Mailing Address - Street 2:STE 109
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-4739
Mailing Address - Country:US
Mailing Address - Phone:425-712-8443
Mailing Address - Fax:425-712-0988
Practice Address - Street 1:2701 184TH ST SW
Practice Address - Street 2:SUITE 109
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-4739
Practice Address - Country:US
Practice Address - Phone:425-712-8443
Practice Address - Fax:425-712-0988
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA911886445152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA911886445OtherTAX ID NUMBER
WA911886445OtherTAX ID NUMBER
WAU53049Medicare UPIN