Provider Demographics
NPI:1326518002
Name:BAILEN, ROBERT (ABO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:BAILEN
Suffix:
Gender:M
Credentials:ABO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 9TH AVE W
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-2810
Mailing Address - Country:US
Mailing Address - Phone:715-209-2435
Mailing Address - Fax:
Practice Address - Street 1:207 2ND AVE W
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-1605
Practice Address - Country:US
Practice Address - Phone:715-682-8181
Practice Address - Fax:715-682-8181
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician