Provider Demographics
NPI:1952432262
Name:THOMPSON, BRADLEY MAJORS (OD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:MAJORS
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 W THIRD ST
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:MS
Mailing Address - Zip Code:39074-4103
Mailing Address - Country:US
Mailing Address - Phone:601-469-3441
Mailing Address - Fax:601-469-3449
Practice Address - Street 1:521 DEERFIELD DRIVE
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:MS
Practice Address - Zip Code:39074-6006
Practice Address - Country:US
Practice Address - Phone:601-469-3441
Practice Address - Fax:601-469-3449
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS659152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00880217Medicaid
1952432262OtherNPI PERSONAL
MS05853379OtherMEDICAID GROUP
1437355096OtherNPI GROUP
5920320001OtherPALMETTO GBA GROUP
U91430Medicare UPIN