Provider Demographics
NPI:1790015675
Name:ELIZABETH A. THOMPSON, O.D., P.A.
Entity Type:Organization
Organization Name:ELIZABETH A. THOMPSON, O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:407-324-5715
Mailing Address - Street 1:451 E ALTAMONTE DR STE 1467
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4616
Mailing Address - Country:US
Mailing Address - Phone:407-830-6546
Mailing Address - Fax:
Practice Address - Street 1:451 E ALTAMONTE DR STE 1467
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4616
Practice Address - Country:US
Practice Address - Phone:407-830-6546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-28
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC002312152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20274Medicare PIN
FLU20798Medicare UPIN