Basic Information
| Provider Information | |||||||||
| NPI: | 1548916372 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TOMPKINS | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | ROBERT | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 896 FARMSTEAD RD | ||||||||
| Address2: | |||||||||
| City: | SUWANEE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300245256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016979927 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3350 BUFORD DR # 230 | ||||||||
| Address2: | |||||||||
| City: | BUFORD | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305194991 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6783182600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2022 | ||||||||
| LastUpdateDate: | 03/02/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OPT003397 | GA | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.