MEDICARE: RACHEL THOMPSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	152W00000X	Optometrist	3202	OK

General Provider Information

NPI Number	:	1073256525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL THOMPSON

Provider Business Mailing Address
First Line	:	1201 KIOWA ST STE A
Second Line	:
City	:	ARDMORE
State	:	OK
Zip	:	73401-2246
Country	:	US
Telephone Number	:	580-223-8585
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 KIOWA ST STE A
Second Line	:
City	:	ARDMORE
State	:	OK
Zip	:	73401-2246
Country	:	US
Telephone Number	:	580-223-8585
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2022
Last Update Date	:	06/27/2023

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Directions to “ RACHEL THOMPSON ” Practice Location

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