Provider Demographics
NPI:1205801941
Name:THOMSEN, JOHN G (OD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:G
Last Name:THOMSEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 DAVIS AVE
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:IA
Mailing Address - Zip Code:50841-1418
Mailing Address - Country:US
Mailing Address - Phone:641-322-3147
Mailing Address - Fax:641-322-3853
Practice Address - Street 1:715 DAVIS AVE
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:IA
Practice Address - Zip Code:50841-1418
Practice Address - Country:US
Practice Address - Phone:641-322-3147
Practice Address - Fax:641-322-3853
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1938T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1081133Medicaid
IA2081133Medicaid
IA41854Medicare UPIN
IAT16275Medicare UPIN
IA07170Medicare ID - Type Unspecified
IA0252060004Medicare NSC