Provider Demographics
NPI:1881890705
Name:THOMPSON, JACQUELINE J (OD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:J
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JACQUELINE
Other - Middle Name:J
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:11486 ENCLAVE BLVD
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-1590
Mailing Address - Country:US
Mailing Address - Phone:317-694-8449
Mailing Address - Fax:
Practice Address - Street 1:1481 W 10TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2803
Practice Address - Country:US
Practice Address - Phone:317-554-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003464A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist