Individual
DR. TRAVIS LEE THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
0618002234
VA
152W00000X
Optometrist
Primary
3122
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103I415320
MEDICARE PTAN
TN
05
—
Q006781
—
TN
Enumeration date
05/30/2013
Last updated
08/26/2014
Update your record
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