Provider Demographics
NPI:1568410504
Name:THOMPSON, SAMUEL E (OD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:E
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 1:615 B HENSON
Mailing Address - Street 2:P O BOX 970
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-0615
Mailing Address - Country:US
Mailing Address - Phone:704-982-2020
Mailing Address - Fax:704-986-4242
Practice Address - Street 1:615 HENSON ST STE B
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-5397
Practice Address - Country:US
Practice Address - Phone:704-982-2020
Practice Address - Fax:704-986-4242
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1204152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7909913Medicaid
NC7909913Medicaid
NC0658780001Medicare NSC