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General NPI Number Information
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NPI Number | 1669491437
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Entity Type | Individual
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Provider Name | STEPHEN R THURMOND O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 06/21/2021
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Provider Practice Location Address
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Address Line | 50 EARL ST SUITE A
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City | CLAYTON
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State | GA
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Zip | 30525
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Country | US
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Telephone | 706-782-3535
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Fax | 706-782-7525
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Provider Business Mailing Address
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Address Line | PO BOX 2105
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City | CLAYTON
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State | GA
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Zip | 30525-0053
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Country | US
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Telephone | 706-782-3535
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Fax | 706-782-7525
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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 | OPT001354
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License Number State | GA
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