Provider Demographics
NPI:1376964650
Name:THOMPSON, NICOLE IRENE (ABOC)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:IRENE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4719 CAMINO DORADO DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78233-6302
Mailing Address - Country:US
Mailing Address - Phone:210-354-7390
Mailing Address - Fax:
Practice Address - Street 1:4719 CAMINO DORADO DR
Practice Address - Street 2:SUITE 1
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78233-6302
Practice Address - Country:US
Practice Address - Phone:210-354-7390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-03
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146151OtherAMERICAN BOARD OF OPTICIANRY