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General NPI Number Information
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NPI Number | 1346241965
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Entity Type | Individual
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Provider Name | TODD P THOMPSON MD
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Gender | Male
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Dates
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Enumeration Date | 08/04/2005
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Last Update Date | 05/10/2018
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Provider Practice Location Address
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Address Line | 1400 US HIGHWAY 1 S
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City | ST AUGUSTINE
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State | FL
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Zip | 32084-4211
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Country | US
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Telephone | 904-829-2286
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Fax | 904-810-5687
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Provider Business Mailing Address
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Address Line | 1400 US HIGHWAY 1 S
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City | ST AUGUSTINE
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State | FL
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Zip | 32084-4211
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Country | US
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Telephone | 904-829-2286
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Fax | 904-810-5687
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | ME84764
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME84764
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License Number State | FL
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