Provider Demographics
NPI:1316007669
Name:BAUER, MAURI DONN (OD)
Entity Type:Individual
Prefix:
First Name:MAURI
Middle Name:DONN
Last Name:BAUER
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 1:5901 SW MACADAM AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3622
Mailing Address - Country:US
Mailing Address - Phone:503-222-2990
Mailing Address - Fax:
Practice Address - Street 1:5901 SW MACADAM AVE
Practice Address - Street 2:STE 105
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3622
Practice Address - Country:US
Practice Address - Phone:503-222-2990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1470-ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist