Individual
KEITH M THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
375 KINGS HWY, PUNTA GORDA, FL 33983-5222
(941) 625-5359
(941) 625-5420
Mailing address
1700 TAMIAMI TRL UNIT G7A, PORT CHARLOTTE, FL 33948-1063
(941) 468-4766
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2418
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
410044567
RR
—
Enumeration date
11/29/2006
Last updated
03/20/2020
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