Provider Demographics
NPI:1013965409
Name:DUMAYAS-BOOTH, GRACE LEA YU (OD)
Entity Type:Individual
Prefix:DR
First Name:GRACE LEA
Middle Name:YU
Last Name:DUMAYAS-BOOTH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:GRACE
Other - Middle Name:LEA
Other - Last Name:DEWARS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4430 MISSOURI AVE # 1263
Mailing Address - Street 2:
Mailing Address - City:FORT LEONARD WOOD
Mailing Address - State:MO
Mailing Address - Zip Code:65473-9098
Mailing Address - Country:US
Mailing Address - Phone:573-596-0048
Mailing Address - Fax:
Practice Address - Street 1:LANDSTUHL REGIONAL MEDICAL CENTER
Practice Address - Street 2:WIESBADEN HEALTH CLINIC UNIT 29623
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09096
Practice Address - Country:DE
Practice Address - Phone:01149611-705-7307
Practice Address - Fax:01149611-705-5984
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002700152W00000X
PAOEG 001649152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist