Healthcare Provider Details

I. General information

NPI: 1013611649
Provider Name (Legal Business Name): MS. TREMIA W BUMPER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6674 WINCHESTER BLVD
CANAL WINCHESTER OH
43110-2048
US

IV. Provider business mailing address

6674 WINCHESTER BLVD
CANAL WINCHESTER OH
43110-2048
US

V. Phone/Fax

Practice location:
  • Phone: 614-833-6831
  • Fax: 614-833-6875
Mailing address:
  • Phone: 614-833-6831
  • Fax: 614-833-6875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number5565S
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: