Provider Demographics
NPI:1790929412
Name:THOMPSON, ANDREW RYAN (ABOC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:RYAN
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 1:4910 DODGE ST STE 107
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68132
Mailing Address - Country:US
Mailing Address - Phone:402-686-0908
Mailing Address - Fax:402-596-5322
Practice Address - Street 1:4910 DODGE ST STE 107
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68132
Practice Address - Country:US
Practice Address - Phone:402-686-0908
Practice Address - Fax:402-596-5322
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-24
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE160458156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist