Provider Demographics
NPI:1285634766
Name:HOWARD, ELIZABETH THOMPSON (OD)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:THOMPSON
Last Name:HOWARD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ANNE
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:2561 JACKSBORO PIKE
Practice Address - Street 2:
Practice Address - City:JACKSBORO
Practice Address - State:TN
Practice Address - Zip Code:37757-4847
Practice Address - Country:US
Practice Address - Phone:423-562-1531
Practice Address - Fax:423-562-1724
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-27
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1660152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3945636Medicaid
TN4047689OtherBLUE CROSS BLUE SHIELD
TN410049805Medicare ID - Type UnspecifiedRAILROAD
TN3940555Medicare ID - Type Unspecified
TN4047689OtherBLUE CROSS BLUE SHIELD