Provider Demographics
NPI:1598899833
Name:THOMPSON, JAMES JAY (ABOC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:JAY
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6842 KELLUM DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46221-4829
Mailing Address - Country:US
Mailing Address - Phone:317-856-8925
Mailing Address - Fax:317-872-6320
Practice Address - Street 1:2436 LAKE CIRCLE DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-4219
Practice Address - Country:US
Practice Address - Phone:317-872-6300
Practice Address - Fax:317-872-6320
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician