Gary G Crook, O. D.
Individual provider Active NPI Optometrist · Augusta, GA
NPI 1366525909 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1366525909
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- OPT000717 (GA)
- Practice address
- 217 Bobby Jones Expy
Augusta, GA 30907-5255 - Phone
- (706) 860-1171
- Fax
- (706) 860-1841
- NPI assigned
- Oct 24, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OPT000717 | GA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| 1 Hour Optical P C | Optometrist | Past |
Accepting new patients |
| Eye Care Associates of SC LLC | Optometrist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OPT000717 | GA | Yes |
Addresses
Primary practice location
217 Bobby Jones Expy
Augusta, GA 30907-5255
Mailing address
217 Bobby Jones Expy
Augusta, GA 30907-5255
Phone (706) 860-1171
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 52540781004 | Other | GA | BCBS |
| DAG983 | Medicaid | SC | |
| GA0717 | Other | GA | EYEMED |
| DPG717 | Medicaid | SC |
Other providers in Augusta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.