Provider Demographics
NPI:1730413923
Name:THOMPSON, BRONWYN S
Entity type:Individual
Prefix:MS
First Name:BRONWYN
Middle Name:S
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 CLIFTON COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-3832
Mailing Address - Country:US
Mailing Address - Phone:518-371-1881
Mailing Address - Fax:518-371-1906
Practice Address - Street 1:22 CLIFTON COUNTRY RD
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3832
Practice Address - Country:US
Practice Address - Phone:518-371-1881
Practice Address - Fax:518-371-1906
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006267-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician