Provider Demographics
NPI:1336285659
Name:BAUER OPTICAL EXPORT CORP
Entity Type:Organization
Organization Name:BAUER OPTICAL EXPORT CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ED
Authorized Official - Middle Name:
Authorized Official - Last Name:KLOTZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:914-478-0550
Mailing Address - Street 1:45 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:10706-1640
Mailing Address - Country:US
Mailing Address - Phone:914-478-0550
Mailing Address - Fax:
Practice Address - Street 1:45 MAIN ST
Practice Address - Street 2:
Practice Address - City:HASTINGS ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:10706-1640
Practice Address - Country:US
Practice Address - Phone:914-478-0550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008357-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5593420001Medicare ID - Type Unspecified