Provider Demographics
NPI:1295847507
Name:BACHMAN, WILLIAM GARY (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GARY
Last Name:BACHMAN
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:ONE UNIVERSITY BLVD
Mailing Address - Street 2:115 MARILLAC HALL
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63121
Mailing Address - Country:US
Mailing Address - Phone:314-516-5131
Mailing Address - Fax:314-516-5507
Practice Address - Street 1:7800 NATURAL BRIDGE RD
Practice Address - Street 2:1 UNIVERSITY BLVD
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63121-4617
Practice Address - Country:US
Practice Address - Phone:314-516-5131
Practice Address - Fax:314-516-5507
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02108152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1295847507Medicaid
MO019006782Medicare PIN
MO007007473Medicare PIN
U06142Medicare UPIN
MO016300005Medicare PIN