Provider Demographics
NPI:1295756922
Name:THOMPSON, ELIZABETH HEASTON (OD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:HEASTON
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 AARON DR
Mailing Address - Street 2:P.O. BOX 610
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4678
Mailing Address - Country:US
Mailing Address - Phone:509-943-3171
Mailing Address - Fax:509-946-0905
Practice Address - Street 1:1321 AARON DR
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4678
Practice Address - Country:US
Practice Address - Phone:509-943-3171
Practice Address - Fax:509-946-0905
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00003815152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00082765OtherRAILROAD MEDICARE
WAG319211100OtherMEDICARE
BLUE CROSS BLUE SHIEOther8890HE
11102OtherGROUP HEALTH
WA0174418OtherWA LABOR AND INDUSTRY
WA2029932Medicaid
P00082765OtherRAILROAD MEDICARE
WAG319211100OtherMEDICARE