Provider Demographics
NPI:1841230612
Name:THOMPSON, EMOKENIOVO OMONO (OD)
Entity type:Individual
Prefix:
First Name:EMOKENIOVO
Middle Name:OMONO
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:OMONO
Other - Middle Name:E
Other - Last Name:OKOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:509 N TENNESSEE ST
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-2889
Mailing Address - Country:US
Mailing Address - Phone:678-935-1000
Mailing Address - Fax:770-342-1011
Practice Address - Street 1:509 N TENNESSEE ST
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-2889
Practice Address - Country:US
Practice Address - Phone:678-935-1000
Practice Address - Fax:770-342-1011
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002178152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist