Provider Demographics
NPI:1598724247
Name:BUMGARNER, GARY DALE (OD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:DALE
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 1:4014 N INDIAN BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99224-9569
Mailing Address - Country:US
Mailing Address - Phone:509-624-7235
Mailing Address - Fax:
Practice Address - Street 1:4014 N INDIAN BLUFF RD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99224-9569
Practice Address - Country:US
Practice Address - Phone:509-624-7235
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA748152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist