Provider Demographics
NPI:1548214562
Name:THOMPSON OCULAR PROSTHETICS, INC.
Entity Type:Organization
Organization Name:THOMPSON OCULAR PROSTHETICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT BOARD CERTIFIED OCULARI
Authorized Official - Prefix:MISS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:BCO
Authorized Official - Phone:210-223-3754
Mailing Address - Street 1:4118 MCCULLOUGH AVE
Mailing Address - Street 2:SUITE 16
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-1979
Mailing Address - Country:US
Mailing Address - Phone:210-223-3754
Mailing Address - Fax:210-223-1949
Practice Address - Street 1:4118 MCCULLOUGH
Practice Address - Street 2:SUITE 16
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-5712
Practice Address - Country:US
Practice Address - Phone:210-223-3754
Practice Address - Fax:210-223-1949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156FX1700X
TX332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX087068501Medicaid
TX513442OtherBLUECROSS BLUESHEILD
TX0441390001Medicare ID - Type Unspecified