Provider Demographics
NPI:1962509927
Name:CHAD J THOMPSON OD CHARTERED
Entity Type:Organization
Organization Name:CHAD J THOMPSON OD CHARTERED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:JUSTIN
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:785-738-3816
Mailing Address - Street 1:206 S MILL ST
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:KS
Mailing Address - Zip Code:67420-3239
Mailing Address - Country:US
Mailing Address - Phone:785-738-3816
Mailing Address - Fax:785-738-4320
Practice Address - Street 1:206 S MILL ST
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:KS
Practice Address - Zip Code:67420-3239
Practice Address - Country:US
Practice Address - Phone:785-738-3816
Practice Address - Fax:785-738-4320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1526152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS6222920001Medicare NSC
KS065128Medicare PIN