Provider Demographics
NPI:1104845908
Name:BAUER, DEAN A (OD)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:A
Last Name:BAUER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7427 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-1817
Mailing Address - Country:US
Mailing Address - Phone:708-771-3334
Mailing Address - Fax:708-771-9614
Practice Address - Street 1:7427 LAKE ST
Practice Address - Street 2:
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-1817
Practice Address - Country:US
Practice Address - Phone:708-771-3334
Practice Address - Fax:708-771-9614
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046007976152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1607956OtherBC/BS ILLINOIS
IL362658561OtherFED TAX ID #
IL1607956OtherBC/BS ILLINOIS
IL183143Medicare ID - Type Unspecified