Healthcare Provider Details

I. General information

NPI: 1629423082
Provider Name (Legal Business Name): THOMPSON EYE CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 05/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 COOLIDGE RD STE #15
EAST LANSING MI
48823-1363
US

IV. Provider business mailing address

2200 COOLIDGE RD STE #15
EAST LANSING MI
48823-1363
US

V. Phone/Fax

Practice location:
  • Phone: 517-977-1598
  • Fax: 517-977-1785
Mailing address:
  • Phone: 517-977-1598
  • Fax: 517-977-1785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901003790
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number4901003790
License Number StateMI

VIII. Authorized Official

Name: DR. STEPHEN P THOMPSON
Title or Position: PRESIDENT
Credential: OD
Phone: 517-977-1598