MEDICARE: BILLY CRAIG THOMPSON OD

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	2200	CO
2	152W00000X	Optometrist	3286TG	TX
3	152W00000X	Optometrist	2302	AR

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

General Provider Information

NPI Number	:	1871601393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BILLY CRAIG THOMPSON OD

Provider Business Mailing Address
First Line	:	2905 CHAMPLIN COURT
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75082-4094
Country	:	US
Telephone Number	:	214-388-9767
Fax Number	:	214-388-4753

Provider Business Practice Location Address
First Line	:	2744 S BUCKNER BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75227-6903
Country	:	US
Telephone Number	:	214-388-9767
Fax Number	:	214-388-4753

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

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	10/18/2010

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