Provider Demographics
NPI:1558349126
Name:GARBUTT, BONNIE S (OD)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:S
Last Name:GARBUTT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:
Other - Last Name:STAHLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:47149 BUSE RD
Mailing Address - Street 2:BLDG 1370
Mailing Address - City:PATUXENT RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:20670-1540
Mailing Address - Country:US
Mailing Address - Phone:301-342-9503
Mailing Address - Fax:301-342-4718
Practice Address - Street 1:47149 BUSE RD
Practice Address - Street 2:BLDG 1370
Practice Address - City:PATUXENT RIVER
Practice Address - State:MD
Practice Address - Zip Code:20670-1540
Practice Address - Country:US
Practice Address - Phone:301-342-9503
Practice Address - Fax:301-342-4718
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5956-T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN