Provider Demographics
NPI:1437112935
Name:CRUMPTON, BRET (DO)
Entity Type:Individual
Prefix:
First Name:BRET
Middle Name:
Last Name:CRUMPTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2616 WARM SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-5642
Mailing Address - Country:US
Mailing Address - Phone:706-323-3491
Mailing Address - Fax:706-660-9191
Practice Address - Street 1:2616 WARM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904
Practice Address - Country:US
Practice Address - Phone:706-323-3491
Practice Address - Fax:706-660-9191
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA47418207W00000X
GA047418207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00829661AMedicaid
GA18BDFNDMedicare ID - Type Unspecified
GA00829661AMedicaid