Healthcare Provider Details

I. General information

NPI: 1689459638
Provider Name (Legal Business Name): MORGAN LEIGH THOMSEN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2023
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4353 DODGE ST
OMAHA NE
68131-2709
US

IV. Provider business mailing address

4353 DODGE ST
OMAHA NE
68131-2709
US

V. Phone/Fax

Practice location:
  • Phone: 402-552-2020
  • Fax: 402-552-2367
Mailing address:
  • Phone: 402-552-2020
  • Fax: 402-552-2367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1646
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD61449440
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: