Provider Demographics
NPI:1720060320
Name:THOMPSON, ELAINE K (OD)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:K
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 1:593 RUSSET BEND DR
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-4330
Mailing Address - Country:US
Mailing Address - Phone:205-428-7404
Mailing Address - Fax:
Practice Address - Street 1:2700 10TH AVE S
Practice Address - Street 2:SUITE 404
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1200
Practice Address - Country:US
Practice Address - Phone:205-933-2340
Practice Address - Fax:205-933-2323
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS609152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051500469OtherBCBS ID
AL10259OtherHEALTH SPRINGS
AL2210205OtherUNITED HEALTH/M'CARE COMP
ALT93650Medicare UPIN
AL051500469Medicare ID - Type UnspecifiedMEDICARE