Provider Demographics
NPI:1659532372
Name:THOMPSON, KATHRYN LEE (OD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:LEE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:13310 WICKLOW PL
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1439
Mailing Address - Country:US
Mailing Address - Phone:301-906-5030
Mailing Address - Fax:
Practice Address - Street 1:5900 GREENBELT RD
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-1010
Practice Address - Country:US
Practice Address - Phone:301-982-4200
Practice Address - Fax:301-441-1093
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002089152W00000X
MDTA2165152W00000X
VA0618001814152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist