Provider Demographics
NPI:1508941717
Name:PLUM, DONALD RICHARD (OD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:RICHARD
Last Name:PLUM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:19336 LEITERSBURG PIKE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742
Mailing Address - Country:US
Mailing Address - Phone:757-249-4330
Mailing Address - Fax:757-249-4303
Practice Address - Street 1:12300 JEFFERSON AVE
Practice Address - Street 2:#417
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602
Practice Address - Country:US
Practice Address - Phone:757-249-4330
Practice Address - Fax:757-249-4303
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0618001217152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA001982N84Medicare ID - Type Unspecified
T26286Medicare UPIN