Provider Demographics
NPI:1639147093
Name:THOMPSON, BENJAMIN CAMPBELL (OD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:CAMPBELL
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 1:1706 E HOLLYBROOK LN
Mailing Address - Street 2:
Mailing Address - City:STIGLER
Mailing Address - State:OK
Mailing Address - Zip Code:74462-3617
Mailing Address - Country:US
Mailing Address - Phone:918-967-9927
Mailing Address - Fax:
Practice Address - Street 1:2204 E MAIN ST
Practice Address - Street 2:
Practice Address - City:STIGLER
Practice Address - State:OK
Practice Address - Zip Code:74462-2822
Practice Address - Country:US
Practice Address - Phone:918-967-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2434152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1502434Medicaid
OKV01539Medicare UPIN