Provider Demographics
NPI:1518903335
Name:THOMPSON, JAMES K (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:K
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 1:5237 JONES CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817
Mailing Address - Country:US
Mailing Address - Phone:225-755-3937
Mailing Address - Fax:225-755-2272
Practice Address - Street 1:5237 JONES CREEK RD
Practice Address - Street 2:SHENANDOAH ETE CLINIC
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-2124
Practice Address - Country:US
Practice Address - Phone:225-755-3937
Practice Address - Fax:225-755-2272
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA745150T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1907375Medicaid
47662Medicare ID - Type Unspecified
19438Medicare UPIN