Provider Demographics
NPI:1942294962
Name:CRUMP, JOSEPH E (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:E
Last Name:CRUMP
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 1:1143 OAK RIDGE TPKE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6422
Mailing Address - Country:US
Mailing Address - Phone:865-483-3031
Mailing Address - Fax:865-483-7641
Practice Address - Street 1:1143 OAK RIDGE TPKE
Practice Address - Street 2:SUITE 103
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6422
Practice Address - Country:US
Practice Address - Phone:865-483-3031
Practice Address - Fax:865-483-7641
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNT718152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN13940OtherPHP TENNCARE
TNTN0718OtherEYEMED
TNOT42164OtherUNITED HEALTHCARE
TN0556440001OtherBCBS-PALMETTO-GOV'T BENEF
TN13940Medicaid
TN0556440001OtherBCBS-PALMETTO-GOV'T BENEF
TN13940OtherPHP TENNCARE