Provider Demographics
NPI:1740224724
Name:THOMPSON, DUANE A (OD)
Entity Type:Individual
Prefix:
First Name:DUANE
Middle Name:A
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 1:431 S MAIN ST
Mailing Address - Street 2:P.O. BOX 465
Mailing Address - City:BROOKFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:64628-2146
Mailing Address - Country:US
Mailing Address - Phone:660-258-7409
Mailing Address - Fax:660-258-4092
Practice Address - Street 1:431 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:MO
Practice Address - Zip Code:64628-2146
Practice Address - Country:US
Practice Address - Phone:660-258-7409
Practice Address - Fax:660-258-4092
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT03466152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1740224724Medicaid
MO410046878Medicare PIN
MO4637030005Medicare NSC
MOP00000840Medicare PIN
MO4637030001Medicare NSC
MO1578733648Medicare PIN
MO4637030003Medicare NSC
MO410046912Medicare PIN
MO4637030002Medicare NSC
MOU75704Medicare UPIN
MO1740224724Medicaid
MO000091319Medicare PIN