1013965409 NPI number — DR. GRACE LEA YU DUMAYAS-BOOTH O.D.

Table of content: DR. GRACE LEA YU DUMAYAS-BOOTH O.D. (NPI 1013965409)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013965409 NPI number — DR. GRACE LEA YU DUMAYAS-BOOTH O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUMAYAS-BOOTH
Provider First Name:
GRACE LEA
Provider Middle Name:
YU
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DEWARS
Provider Other First Name:
GRACE
Provider Other Middle Name:
LEA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1013965409
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4430 MISSOURI AVE # 1263
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT LEONARD WOOD
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65473-9098
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-596-0048
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
LANDSTUHL REGIONAL MEDICAL CENTER
Provider Second Line Business Practice Location Address:
WIESBADEN HEALTH CLINIC UNIT 29623
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AE
Provider Business Practice Location Address Postal Code:
09096
Provider Business Practice Location Address Country Code:
DE
Provider Business Practice Location Address Telephone Number:
011496117057307
Provider Business Practice Location Address Fax Number:
011496117055984
Provider Enumeration Date:
05/05/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  0618002700 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: OEG 001649 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)