Provider Demographics
NPI:1881893840
Name:WHITNEY THOMPSON OPTOMETRY PSC
Entity type:Organization
Organization Name:WHITNEY THOMPSON OPTOMETRY PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WHITNEY
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:GENTRY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:270-629-6060
Mailing Address - Street 1:337 JARED TYLER RD
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-3540
Mailing Address - Country:US
Mailing Address - Phone:270-670-8666
Mailing Address - Fax:
Practice Address - Street 1:705 N RACE ST
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-3040
Practice Address - Country:US
Practice Address - Phone:270-629-6060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1703DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100010550Medicaid
KY00414001Medicare PIN
KY7100010550Medicaid