Healthcare Provider Details

I. General information

NPI: 1720060320
Provider Name (Legal Business Name): ELAINE K THOMPSON O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 02/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 10TH AVE S SUITE 404
BIRMINGHAM AL
35205-1200
US

IV. Provider business mailing address

593 RUSSET BEND DR
HOOVER AL
35244-4330
US

V. Phone/Fax

Practice location:
  • Phone: 205-933-2340
  • Fax: 205-933-2323
Mailing address:
  • Phone: 205-428-7404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberS609
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: