Provider Demographics
NPI:1245450873
Name:DOROTHY THOMPSON, OPTOMETRIST, PSC
Entity type:Organization
Organization Name:DOROTHY THOMPSON, OPTOMETRIST, PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:JEANNE
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:859-498-4777
Mailing Address - Street 1:420 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-1345
Mailing Address - Country:US
Mailing Address - Phone:859-498-4777
Mailing Address - Fax:859-498-3392
Practice Address - Street 1:420 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-1345
Practice Address - Country:US
Practice Address - Phone:859-498-4777
Practice Address - Fax:859-498-3392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1089DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77010890Medicaid
KY77010890Medicaid
KY1870201Medicare PIN