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Individual

DR. BRADLEY MAJORS THOMPSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
521 DEERFIELD DRIVE, FOREST, MS 39074-6006
(601) 469-3441
(601) 469-3449
Mailing address
143 W THIRD ST, FOREST, MS 39074-4103
(601) 469-3441
(601) 469-3449

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
659
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00880217
MS
01
05853379
MEDICAID GROUP
MS
01
1437355096
NPI GROUP
01
1952432262
NPI PERSONAL
01
5920320001
PALMETTO GBA GROUP
Enumeration date
03/08/2007
Last updated
12/04/2019
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