Provider Demographics
NPI:1245756105
Name:LUMPKIN, JAKE (OD)
Entity Type:Individual
Prefix:DR
First Name:JAKE
Middle Name:
Last Name:LUMPKIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2870 HIGHWAY 69A
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:TN
Mailing Address - Zip Code:38320-6190
Mailing Address - Country:US
Mailing Address - Phone:731-431-6078
Mailing Address - Fax:
Practice Address - Street 1:10705 W COLFAX AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-3813
Practice Address - Country:US
Practice Address - Phone:130-344-5944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-22
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0003347152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist