Provider Demographics
NPI:1235296609
Name:BACHO, ALAN JAMES (OD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:JAMES
Last Name:BACHO
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 1:1104 ROUTE 130 N
Mailing Address - Street 2:STE T
Mailing Address - City:CINNAMINSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077-3032
Mailing Address - Country:US
Mailing Address - Phone:856-303-1506
Mailing Address - Fax:856-499-2412
Practice Address - Street 1:1104 ROUTE 130 N
Practice Address - Street 2:SUITE T
Practice Address - City:CINNAMINSON
Practice Address - State:NJ
Practice Address - Zip Code:08077-3032
Practice Address - Country:US
Practice Address - Phone:856-303-1506
Practice Address - Fax:856-499-2412
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00470000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ77293OtherAETNA
NJ77293OtherAETNA
099778U8MMedicare PIN