Provider Demographics
NPI:1922722743
Name:THOMPSON, RICHARD KENNETH (LDO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:KENNETH
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29665 BURTONS SHORE RD
Mailing Address - Street 2:0072
Mailing Address - City:LOCUSTVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23404-0072
Mailing Address - Country:US
Mailing Address - Phone:848-404-8329
Mailing Address - Fax:
Practice Address - Street 1:29665 BURTONS SHORE RD
Practice Address - Street 2:0072
Practice Address - City:LOCUSTVILLE
Practice Address - State:VA
Practice Address - Zip Code:23404-0072
Practice Address - Country:US
Practice Address - Phone:848-404-8329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101004497156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician