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NPI Code Detail

MEDICARE: DR. KALEN MILES THOMPSON OD

MEDICARE: DR. KALEN MILES THOMPSON OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2152W00000XOptometristOPC6244FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1OPC6244OTHERFLPROFESSIONAL LISCENSE

General Provider Information

NPI Number : 1124712948
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KALEN MILES THOMPSON OD
Provider Business Mailing Address
First Line : 2003 CORTEZ RD W
Second Line :
City : BRADENTON
State : FL
Zip : 34207-1241
Country : US
Telephone Number : 941-756-2020
Fax Number :
Provider Business Practice Location Address
First Line : 2003 CORTEZ RD W
Second Line :
City : BRADENTON
State : FL
Zip : 34207-1241
Country : US
Telephone Number : 941-756-2020
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2023
Last Update Date : 10/03/2024

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