Provider Demographics
NPI:1518072909
Name:STUMP, REBECCA ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:ANN
Last Name:STUMP
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15 KINDLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1908
Mailing Address - Country:US
Mailing Address - Phone:740-441-2151
Mailing Address - Fax:740-441-0706
Practice Address - Street 1:2145 EASTERN AVE
Practice Address - Street 2:WAL-MART VISION CENTER
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1873
Practice Address - Country:US
Practice Address - Phone:740-441-2151
Practice Address - Fax:740-441-0706
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4148152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU09816Medicare UPIN