Healthcare Provider Details

I. General information

NPI: 1073584439
Provider Name (Legal Business Name): JOHN TILYNN THOMPSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27160 BAY LANDING DR STE 100
BONITA SPRINGS FL
34135-4301
US

IV. Provider business mailing address

6333 N FEDERAL HWY STE 300
FORT LAUDERDALE FL
33308-1909
US

V. Phone/Fax

Practice location:
  • Phone: 239-390-1014
  • Fax: 239-390-0445
Mailing address:
  • Phone: 954-776-6880
  • Fax: 954-229-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME160300
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberME160300
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: