Provider Demographics
NPI:1043240757
Name:COMPTON, RENEE S (OD)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:S
Last Name:COMPTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IN
Mailing Address - Zip Code:47167-1040
Mailing Address - Country:US
Mailing Address - Phone:812-883-2700
Mailing Address - Fax:812-883-2752
Practice Address - Street 1:600 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IN
Practice Address - Zip Code:47167-1040
Practice Address - Country:US
Practice Address - Phone:812-883-2700
Practice Address - Fax:812-883-2752
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003404A152W00000X
KY1678DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000531030OtherANTHEM BCBS
IN200854690Medicaid
IN18003404AOtherOD LICENSE NUMBER
KY7100025620Medicaid
KY1678DTOtherOD LICENSE NUMBER
IN221390EMedicare PIN
KY7100025620Medicaid
KY5419240002Medicare NSC
KY1678DTOtherOD LICENSE NUMBER
KY0941016Medicare PIN