Provider Demographics
NPI:1578819835
Name:THOMPSON, COURTNEY (OD)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:THOMPSON
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:PO BOX 2355
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39158-2355
Mailing Address - Country:US
Mailing Address - Phone:769-208-8930
Mailing Address - Fax:769-208-8831
Practice Address - Street 1:350 W WOODROW WILSON AVE
Practice Address - Street 2:SUITE 3110
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39213-7681
Practice Address - Country:US
Practice Address - Phone:601-366-9020
Practice Address - Fax:601-321-3979
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS867152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist