Individual provider Active NPI

Paul Jon Thompson, O.D.

  • Optometrist
  • Las Vegas, NV
National Provider Identifier
1104839026
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
391 Issued in NV
Practice address
4505 W Charleston Blvd
Las Vegas, NV 89102-1501
Phone
(702) 822-2202
Fax
(702) 822-2274
NPI assigned
Aug 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 391 NV Primary

Addresses

Primary practice location

4505 W Charleston Blvd
Las Vegas, NV 89102-1501

Mailing address

PO Box 28340
Las Vegas, NV 89126-2340
Phone (702) 822-2202

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050110001106 NV Practitioner - Optometry 6103874755 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Ohio State University - College of Optometry, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

4505 W Charleston Blvd
Las Vegas, NV 89102-1501
Phone (702) 822-2202

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
391NVMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Paul Thompson OD PC Optometrist CurrentSince Nov 29, 2004 Accepting new patients

Locations

4505 W Charleston Blvd
Las Vegas, NV 89102
Phone (702) 258-5075

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104839026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 28340",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891262340",
            "telephone_number": "702-822-2202",
            "fax_number": "702-822-2274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4505 W CHARLESTON BLVD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891021501",
            "telephone_number": "702-822-2202",
            "fax_number": "702-822-2274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMPSON",
        "first_name": "PAUL",
        "middle_name": "JON",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NV",
            "license": "391",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.