Provider Demographics
NPI:1770739617
Name:THOMPSON, TAYLOR GARY (OD)
Entity type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:GARY
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18750 E KINGBIRD DR
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85242-7997
Mailing Address - Country:US
Mailing Address - Phone:503-764-7632
Mailing Address - Fax:
Practice Address - Street 1:8340 W MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-4101
Practice Address - Country:US
Practice Address - Phone:623-936-0613
Practice Address - Fax:623-936-0653
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1634152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist