Provider Demographics
NPI:1548612351
Name:THOMPSON-GOZUM, EMY (OD)
Entity Type:Individual
Prefix:DR
First Name:EMY
Middle Name:
Last Name:THOMPSON-GOZUM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5979 DESERT STORM AVE
Mailing Address - Street 2:
Mailing Address - City:FORT CAMPBELL
Mailing Address - State:KY
Mailing Address - Zip Code:42223-5514
Mailing Address - Country:US
Mailing Address - Phone:210-313-5387
Mailing Address - Fax:
Practice Address - Street 1:4959 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-2727
Practice Address - Country:US
Practice Address - Phone:210-313-5387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3320152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist