Healthcare Provider Details

I. General information

NPI: 1164574117
Provider Name (Legal Business Name): THOMPSON EYE CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 06/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11005 W 60TH ST SUITE 210
SHAWNEE KS
66203-2789
US

IV. Provider business mailing address

11005 W 60TH ST SUITE 210
SHAWNEE KS
66203-2789
US

V. Phone/Fax

Practice location:
  • Phone: 913-631-7700
  • Fax: 913-631-8080
Mailing address:
  • Phone: 913-631-7700
  • Fax: 913-631-8080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number0429611
License Number StateKS

VIII. Authorized Official

Name: DR. ROBERT W THOMPSON JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 913-631-7700