Provider Demographics
NPI:1407913866
Name:THOMPSON, BILLY C (OD)
Entity Type:Individual
Prefix:DR
First Name:BILLY
Middle Name:C
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2391 PEACHTREE RD NE
Mailing Address - Street 2:STE. B3A6
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-4119
Mailing Address - Country:US
Mailing Address - Phone:404-237-4922
Mailing Address - Fax:404-237-4712
Practice Address - Street 1:2391 PEACHTREE RD NE
Practice Address - Street 2:STE. B3A6
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-4119
Practice Address - Country:US
Practice Address - Phone:404-237-4922
Practice Address - Fax:404-237-4712
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001123152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU11345Medicare UPIN
GA41-2CBNVMedicare ID - Type Unspecified