Provider Demographics
NPI:1184708588
Name:THOMPSON, LAURA ANNE (OD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ANNE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4976 ALPHA LN
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-5470
Mailing Address - Country:US
Mailing Address - Phone:423-497-5355
Mailing Address - Fax:423-308-0281
Practice Address - Street 1:1210 PREMIER DR STE 110
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3747
Practice Address - Country:US
Practice Address - Phone:423-385-2020
Practice Address - Fax:423-385-2021
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2186152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
28264OtherUNITED HEALTH CARE
6036108OtherBCBS
TN3943556Medicaid
100039447OtherCARITEN PHP
TN3943556Medicaid