Provider Demographics
NPI:1598197501
Name:BUMGARDNER, REBECCA DAWN (OD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:DAWN
Last Name:BUMGARDNER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3332 PRINCESS ANNE RD
Mailing Address - Street 2:SUITE 611
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-2613
Mailing Address - Country:US
Mailing Address - Phone:757-368-2828
Mailing Address - Fax:
Practice Address - Street 1:3332 PRINCESS ANNE RD
Practice Address - Street 2:SUITE 611
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-2613
Practice Address - Country:US
Practice Address - Phone:757-368-2828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1761152W00000X
VA0618002245152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist