Provider Demographics
NPI:1164401634
Name:GAUER, BONNIE MARIE (OD)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:MARIE
Last Name:GAUER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 NW MEDICAL LOOP
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-1645
Mailing Address - Country:US
Mailing Address - Phone:541-440-2590
Mailing Address - Fax:541-440-9285
Practice Address - Street 1:320 NW MEDICAL LOOP
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-1645
Practice Address - Country:US
Practice Address - Phone:541-440-2590
Practice Address - Fax:541-440-9285
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2014-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3054AT152W00000X
WA3097TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR06254900000OtherREGENCE BCBS REGULAR
OR126636Medicaid
OR731676813OtherSAIF CORP
OR289F9GAOtherBCBS MINNESOTA
OR731676813OtherLIFEWISE OF OREGON
OR731676813OtherPYRAMID LIFE
OR731676813OtherUNITED HEALTHCARE
OR731676813OtherPROVIDENCE HEALTH
OR09042OtherPACIFICSOURCE
ORCR0000PHDBROtherUNITED AM INS CO
ORP00087069OtherRAILROAD MEDICARE
OR73167681308E729OtherREGENCE BCBS FED PROG
ORPR47149760001OtherCIGNA HEALTHCARE
OR430347-01OtherREGENCE BCBS PC65
OR731676813OtherODS
OR731676813OtherSTATE FARM INSURANCE
OR731676813974700000OtherTRIWEST/TRICARE/CHAMPUS
OR731676813OtherMUTUAL OF OMAHA
OR731676813974700000OtherTRIWEST/TRICARE/CHAMPUS
ORCR0000PHDBROtherUNITED AM INS CO