MEDICARE: DR. KRISTEN M 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
1	152W00000X	Optometrist	5107	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000330233	OTHER	OH	ANEHEM

General Provider Information

NPI Number	:	1225053762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTEN M THOMPSON OD

Provider Business Mailing Address
First Line	:	26 SOUTH URBANA ST.
Second Line	:	PO BOX 190
City	:	SOUTH VIENNA
State	:	OH
Zip	:	45369-0000
Country	:	US
Telephone Number	:	937-568-7200
Fax Number	:

Provider Business Practice Location Address
First Line	:	26 SOUTH URBANA ST.
Second Line	:
City	:	SOUTH VIENNA
State	:	OH
Zip	:	45369-0000
Country	:	US
Telephone Number	:	937-568-7200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	06/09/2009

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