Individual
TRAVIS W THOMPSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1921 STONECIPHER DR, ADA, OK 74820-3439
(580) 436-3980
Mailing address
1921 STONECIPHER DR, ADA, OK 74820-3439
(580) 436-3980
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2716
OK
Other
Enumeration date
07/28/2011
Last updated
01/07/2015
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