Provider Demographics
NPI:1982608477
Name:THORNHILL, BRENDA KAYE (OD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:KAYE
Last Name:THORNHILL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 15TH ST
Mailing Address - Street 2:STE 5D
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-4130
Mailing Address - Country:US
Mailing Address - Phone:601-553-2100
Mailing Address - Fax:601-553-2104
Practice Address - Street 1:2024 15TH ST
Practice Address - Street 2:STE 5D
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4130
Practice Address - Country:US
Practice Address - Phone:601-553-2100
Practice Address - Fax:601-553-2104
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS617152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00880094Medicaid
MS410039252OtherRAILROAD MEDICARE
MS00880094Medicaid
MS410039252OtherRAILROAD MEDICARE