MEDICARE: DR. BILLY C. THOMPSON O.D.

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	152W00000X	Optometrist	OPT001123	GA

General Provider Information

NPI Number	:	1407913866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BILLY C. THOMPSON O.D.

Provider Business Mailing Address
First Line	:	2391 PEACHTREE RD NE
Second Line	:	STE. B3A6
City	:	ATLANTA
State	:	GA
Zip	:	30305-4119
Country	:	US
Telephone Number	:	404-237-4922
Fax Number	:	404-237-4712

Provider Business Practice Location Address
First Line	:	2391 PEACHTREE RD NE
Second Line	:	STE. B3A6
City	:	ATLANTA
State	:	GA
Zip	:	30305-4119
Country	:	US
Telephone Number	:	404-237-4922
Fax Number	:	404-237-4712

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

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	07/08/2007

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