Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist |
NPI | 1306859103 |
---|---|
Provider Name | Jean G Thompson |
First Address | San Antonio, TX 78212-1979 |
Second Address | San Antonio, TX 78212-1979 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
513442 | BLUECROSS BLUESHIELD (01) | TX |