Provider Demographics
NPI:1144216730
Name:BASHKOFF, DEBRA L (OD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:L
Last Name:BASHKOFF
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:704 THIMBLE SHOALS BLVD
Mailing Address - Street 2:#100
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4544
Mailing Address - Country:US
Mailing Address - Phone:757-595-8404
Mailing Address - Fax:757-595-8353
Practice Address - Street 1:704 THIMBLE SHOALS BLVD
Practice Address - Street 2:#100
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4544
Practice Address - Country:US
Practice Address - Phone:757-595-8404
Practice Address - Fax:757-595-8353
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000430152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U56680Medicare UPIN