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General NPI Number Information
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NPI Number | 1013965409
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Entity Type | Individual
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Provider Name | GRACE LEA YU DUMAYAS-BOOTH O.D.
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Gender | Female
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 06/18/2021
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Provider Practice Location Address
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Address Line | LANDSTUHL REGIONAL MEDICAL CENTER WIESBADEN HEALTH CLINIC UNIT 29623
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City | APO
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State | AE
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Zip | 09096
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Country | DE
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Telephone | 011496117057307
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Fax | 011496117055984
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Provider Business Mailing Address
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Address Line | 4430 MISSOURI AVE # 1263
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City | FORT LEONARD WOOD
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State | MO
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Zip | 65473-9098
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Country | US
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Telephone | 573-596-0048
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0618002700
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OEG 001649
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License Number State | PA
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