Provider Demographics
NPI:1871642546
Name:THOMPSON, MELINDA RAQUEL (OPTOMETRIST)
Entity Type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:RAQUEL
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:OPTOMETRIST
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Mailing Address - Street 1:714 SAINT ANDREWS WAY
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-1327
Mailing Address - Country:US
Mailing Address - Phone:805-733-0165
Mailing Address - Fax:805-733-0165
Practice Address - Street 1:425 W CENTRAL AVE
Practice Address - Street 2:STE 102
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-2805
Practice Address - Country:US
Practice Address - Phone:805-736-2020
Practice Address - Fax:805-737-1733
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA9373152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist