Provider Demographics
NPI:1518095017
Name:THOMPSON, BRIAN (RDO)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:RDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 EL CAMINO REAL
Mailing Address - Street 2:STE 102
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-2305
Mailing Address - Country:US
Mailing Address - Phone:650-326-9111
Mailing Address - Fax:
Practice Address - Street 1:855 EL CAMINO REAL
Practice Address - Street 2:STE 102
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2305
Practice Address - Country:US
Practice Address - Phone:650-326-9111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASL146156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician