Provider Demographics
NPI:1437355096
Name:BRADLEY M. THOMPSON, O.D.,P.A.
Entity Type:Organization
Organization Name:BRADLEY M. THOMPSON, O.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-469-3441
Mailing Address - Street 1:143 W THIRD ST
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:MS
Mailing Address - Zip Code:39074-4103
Mailing Address - Country:US
Mailing Address - Phone:601-469-3441
Mailing Address - Fax:601-469-3449
Practice Address - Street 1:143 W THIRD ST
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:MS
Practice Address - Zip Code:39074-4103
Practice Address - Country:US
Practice Address - Phone:601-469-3441
Practice Address - Fax:601-469-3449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS659152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00087620Medicaid
MS00880217Medicaid
MS05853379Medicaid
MS00087620Medicaid
U91430Medicare UPIN
MS5920320001Medicare NSC