Healthcare Provider Details

I. General information

NPI: 1871780536
Provider Name (Legal Business Name): THOMPSON FAMILY EYECARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 11/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 HAWTHORNE DR SUITE 300
PLAINFIELD IN
46168-1894
US

IV. Provider business mailing address

1620 HAWTHORNE DR SUITE 300
PLAINFIELD IN
46168-1894
US

V. Phone/Fax

Practice location:
  • Phone: 317-838-0202
  • Fax: 317-838-0027
Mailing address:
  • Phone: 317-838-0202
  • Fax: 317-838-0027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number18002218
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. TOD WILLIAM THOMPSON
Title or Position: PRESIDENT
Credential: O.D.
Phone: 317-838-0202