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Individual

KYLE THOMPSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
OD

Contact information

Practice address
553 18TH ST, ASTORIA, OR 97103-3505
(503) 325-4401
Mailing address
819 S HOLLADAY DR, SEASIDE, OR 97138-6608

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
AT4590
OR
152W00000X
Optometrist
OD61205654
WA

Other

Enumeration date
07/21/2021
Last updated
09/14/2021
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