Provider Demographics
NPI:1740824119
Name:KRUMAN, BROOKE D (OD)
Entity type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:D
Last Name:KRUMAN
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 1:20000 N 57TH AVE
Mailing Address - Street 2:RM P109
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-7209
Mailing Address - Country:US
Mailing Address - Phone:360-773-6043
Mailing Address - Fax:
Practice Address - Street 1:4502 E OAK ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-2411
Practice Address - Country:US
Practice Address - Phone:602-808-0101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-29
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ002394152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ002394OtherARIZONA STATE BOARD