Healthcare Provider Details

I. General information

NPI: 1669569141
Provider Name (Legal Business Name): DOROTHY C. THOMASON O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 JOEL DR
FORT CAMPBELL KY
42223-5318
US

IV. Provider business mailing address

PO BOX 1094
FORT CAMPBELL KY
42223-7094
US

V. Phone/Fax

Practice location:
  • Phone: 270-412-2966
  • Fax:
Mailing address:
  • Phone: 704-122-9662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT1470
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberT1470
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: