Provider Demographics
NPI:1881661387
Name:THOMPSON, ROBERT F
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:F
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-3475
Mailing Address - Country:US
Mailing Address - Phone:989-799-2860
Mailing Address - Fax:989-799-9954
Practice Address - Street 1:3210 STATE ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-3475
Practice Address - Country:US
Practice Address - Phone:989-799-2860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002318152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
900G31124OtherBCBS MICHIGAN
MI944346425Medicaid
MI2683630001Medicare NSC
MI944346425Medicaid
MIT33560Medicare UPIN
MI1056440004Medicare NSC