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General NPI Number Information
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NPI Number | 1245582154
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Entity Type | Individual
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Provider Name | MICHELE DESJARDINS THOMPSON O.D.
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Gender | Female
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Dates
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Enumeration Date | 10/03/2012
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Last Update Date | 10/03/2012
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Provider Practice Location Address
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Address Line | 4338 AMBOY RD
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City | STATEN ISLAND
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State | NY
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Zip | 10312-3820
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Country | US
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Telephone | 718-494-1319
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Fax |
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Provider Business Mailing Address
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Address Line | 101 W RIVER RD
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City | RUMSON
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State | NJ
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Zip | 07760-1124
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Country | US
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Telephone | 732-345-0247
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 005282
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27TO00089800
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27OA00541000
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License Number State | NJ
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27OM00090800
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License Number State | NJ
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