Jack Benjamin Brumberg, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT000993 Issued in GA

Practice address

1030 13TH St
Columbus, GA 31901-2240

Phone

(706) 327-3937

Fax

(706) 596-6658

NPI assigned

Jul 10, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Depoe Eye Center PC

  • Optometrist
  • Stockbridge, GA
  • NPI 1073730263
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561939200000",
    "number": "1821022443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1030 13TH ST",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319012240",
            "telephone_number": "706-327-3937",
            "fax_number": "706-596-6658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1030 13TH ST",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319012240",
            "telephone_number": "706-327-3937",
            "fax_number": "706-596-6658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUMBERG",
        "first_name": "JACK",
        "middle_name": "BENJAMIN",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-10",
        "last_updated": "2019-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT000993",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ethan D Brubaker, PA-C
• Bruce a Boretsky DMD, LLC
• Pamela Bruce
• Terry Bruce
• Samantha Meghan Bruffy
• Paulette A Bruno
• Shirlene Brunson
• Mary Bailey Wickham Bryan, PA-C
• Karen R. Bryans, LPC
• Candice Bryant, RBT

• Optometrist in Columbus, GA
• Providers in Columbus, GA by specialty
• Optometrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.