Provider Demographics
NPI:1093703415
Name:BAILEY, ERIC SCOTT (OD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:SCOTT
Last Name:BAILEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2416 MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-2424
Mailing Address - Country:US
Mailing Address - Phone:320-250-6254
Mailing Address - Fax:888-785-9518
Practice Address - Street 1:1447 E 7TH ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-4666
Practice Address - Country:US
Practice Address - Phone:763-295-5600
Practice Address - Fax:888-785-9518
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2232152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN117259OtherUCARE
MN1134353170OtherTRICARE
MN1093703415OtherPREFERRED ONE
168088OtherEYEMED
MN22-05300OtherMEDICA
MN507016300Medicaid
MN3C409BAOtherBCBS OF MN
MN1134353170OtherMMSI / MAYO MGMT
MN1093703415OtherPREFERRED ONE
MN507016300Medicaid