Provider Demographics
NPI:1376131300
Name:THOMPSON COLLAB PLLC
Entity Type:Organization
Organization Name:THOMPSON COLLAB PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:210-452-4951
Mailing Address - Street 1:1009 NW LOOP 410
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-2221
Mailing Address - Country:US
Mailing Address - Phone:210-366-1021
Mailing Address - Fax:210-340-3587
Practice Address - Street 1:1009 NW LOOP 410
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-2221
Practice Address - Country:US
Practice Address - Phone:210-366-1021
Practice Address - Fax:210-340-3587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty