MEDICARE: DR. LAURIE L 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	OPT.0003240	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	OPT.0003240	OTHER	CO	CO OPTOMETRY LICENSE

General Provider Information

NPI Number	:	1679925804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURIE L THOMPSON O.D.

Provider Business Mailing Address
First Line	:	2221 E BIJOU ST STE 100
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-8009
Country	:	US
Telephone Number	:	719-576-1850
Fax Number	:	719-955-3470

Provider Business Practice Location Address
First Line	:	2857 E FOUNTAIN BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910-2312
Country	:	US
Telephone Number	:	719-329-1221
Fax Number	:	719-329-1511

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

Provider Enumeration Date	:	07/12/2016
Last Update Date	:	06/12/2019

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