MAXIMILLIAN SCOTT CROCKETT (NPI# 1255930160) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255930160 |
| Entity Type | Individual |
| Full Name | MAXIMILLIAN SCOTT CROCKETT |
| Credential | OD |
| Practice Address |
James. H Quillen Vamc, Eye Clinic 112e Mountain Home TN 37684 |
| Practice Telephone | 4239261171 |
| Mailing Telephone | 4239261171 |
| Enumeration Date | 2020-10-21 |
| Last Update Date | 2020-10-21 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 152W00000X | Optometrist | OPT.0003630 | CO | Eye and Vision Services Providers |
| Street Address |
JAMES. H QUILLEN VAMC, EYE CLINIC 112E |
| City | MOUNTAIN HOME |
| State | TN |
| Zip Code | 37684 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235730524 | Kendra Lee Thorne | Psychologist | Corner of Lamont St and Veterans Way, Building 160, Mountain Home, TN 37684 | 2020-11-04 |
| 1699393256 | Joshua Thomas Spencer | Pharmacist | Veterans Way and Lamont St, Mountain Home, TN 37684 | 2020-07-10 |
| 1073140265 | James Hankil Kim | Student in an Organized Health Care Education/Training Program | Building 52/lake Drive, Mountain Home, TN 37684 | 2020-03-26 |
| 1932736030 | Trishna Sharma | Student in an Organized Health Care Education/Training Program | Building 52/lake Drive Mountain Home, Johnson City, TN 37684 | 2020-03-26 |
| 1508421884 | Sarvatit Patel | Student in an Organized Health Care Education/Training Program | 52 Lake Dr, Mountain Home, TN 37684 | 2019-05-02 |
| 1902366024 | Katelyn Cserjes | Student in an Organized Health Care Education/Training Program | Building 52 Lake Drive Va Medical Center, Mountain Home, TN 37684 | 2019-03-24 |
| 1114404282 | Anesa Ellen Hughes | Pharmacist | Veterans Way and Lamont St Mountain Home, Mountain Home, TN 37684 | 2018-07-23 |
| 1508352287 | Leon Nguyen | Optometrist | James H. Quillen Vamc - Lamont St & Veterans Way, Eye Clinic 112e, Mountain Home, TN 37684 | 2018-07-06 |
| 1649761750 | Bahaaeldin Ibrahim Mahmoud Youssef | Student in an Organized Health Care Education/Training Program | Va Building 1 Carl A Jones Hall, Dogwood Avenue, Mountain Home, TN 37684 | 2018-05-24 |
| 1447776075 | Mekindra Williams | Nurse Practitioner | James H Quillen Va Healthcare System, Corner of Lamont and Veterans Way, Mountian Home, TN 37684 | 2017-08-15 |
| Find all providers in zip 37684 | ||||
| Taxonomy Code | 152W00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. |
| Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508352287 | Leon Nguyen | Optometrist | James H. Quillen Vamc - Lamont St & Veterans Way, Eye Clinic 112e, Mountain Home, TN 37684 | 2018-07-06 |
| 1477926830 | Dara Auyeung | Optometrist | Eye Clinic 112e, Mountain Home, TN 37684-4000 | 2015-11-07 |
| 1538596671 | Dong Chan Suk | Optometrist | 99 Sidney St, Eye Clinic, Mountain Home, TN 37684 | 2013-10-03 |
| 1770713240 | Gary Michael Nadolsky | Optometrist | Corner of Lamont and Sydney Streets Building 200, Mountain Home, TN 37684 | 2009-07-19 |
| 1770748873 | Jonathan Paul Norris | Optometrist | 265 N 3rd E, Mountain Home, ID 83647-2734 | 2008-07-28 |
| 1801066360 | Hubert L. Cockrum Od Pa | Optometrist | 2183 Highway 62 W, Mountain Home, AR 72653-6500 | 2008-03-11 |
| 1487719423 | Langevin Vision Clinic | Optometrist | 115 South College Street, Mountain Home, AR 72653 | 2006-12-27 |
| 1841304391 | Dax Alan Gay | Optometrist | 809 Lamont Street, Mountain Home, TN 37684 | 2006-08-19 |
| 1700999448 | Nanette M Coelho | Optometrist | Building 8, Vamc Eye Clinic, Mountain Home, TN 37684 | 2006-08-16 |
| 1861405243 | Whitney D Mcfall | Optometrist | 360 Highway 5 N, Mountain Home, AR 72653-3039 | 2006-08-15 |
| Find all providers in MOUNTAIN HOME | ||||
| City | MOUNTAIN HOME |
| Zip Code | 37684 |
Please comment or provide details below to improve the information on MAXIMILLIAN SCOTT CROCKETT.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.