Provider Demographics
NPI:1578590360
Name:BUMGARNER, LORANCE KENNEDY (OD)
Entity Type:Individual
Prefix:
First Name:LORANCE
Middle Name:KENNEDY
Last Name:BUMGARNER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 FOX HOLLOW
Mailing Address - Street 2:SPECTRUM FAMILY EYE CENTER SUITE 100
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374
Mailing Address - Country:US
Mailing Address - Phone:910-692-3937
Mailing Address - Fax:910-692-5908
Practice Address - Street 1:160 FOX HOLLOW
Practice Address - Street 2:SPECTRUM FAMILY EYE CENTER SUITE 100
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374
Practice Address - Country:US
Practice Address - Phone:910-692-3937
Practice Address - Fax:910-692-5908
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1042152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7909135Medicaid
9135OtherBCBS
NC4443160001Medicare NSC
246560EMedicare PIN
NC7909135Medicaid