Healthcare Provider Details

I. General information

NPI: 1730237579
Provider Name (Legal Business Name): STEPHEN P THOMPSON O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

2200 COOLIDGE RD #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 Number2578
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1730237579
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG004327
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901003790
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2025030938
License Number StateMO
# 6
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number129690
License Number StateIA
# 7
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3391
License Number StateCT
# 8
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.0004169
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: