Provider Demographics
NPI:1396350203
Name:THOMPSON, MALLORY ELORA (OD)
Entity type:Individual
Prefix:DR
First Name:MALLORY
Middle Name:ELORA
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 162264
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32716-2264
Mailing Address - Country:US
Mailing Address - Phone:941-792-2020
Mailing Address - Fax:941-743-5158
Practice Address - Street 1:1940 TAMIAMI TRL STE 103
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-2105
Practice Address - Country:US
Practice Address - Phone:941-792-2020
Practice Address - Fax:941-743-5158
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5853152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist