Provider Demographics
NPI:1871601393
Name:THOMPSON, BILLY CRAIG (OD)
Entity type:Individual
Prefix:
First Name:BILLY
Middle Name:CRAIG
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:BILL
Other - Middle Name:C
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OPTOMETRIST
Mailing Address - Street 1:2905 CHAMPLIN COURT
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-4094
Mailing Address - Country:US
Mailing Address - Phone:214-388-9767
Mailing Address - Fax:214-388-4753
Practice Address - Street 1:2744 S BUCKNER BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-6903
Practice Address - Country:US
Practice Address - Phone:214-388-9767
Practice Address - Fax:214-388-4753
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2200152W00000X
TX3286TG152W00000X
AR2302152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019261902Medicaid
T16268Medicare UPIN
TX019261902Medicaid