Provider Demographics
NPI:1346340619
Name:BAILEY, DAVID W (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:BAILEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2216 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-1922
Mailing Address - Country:US
Mailing Address - Phone:716-373-0991
Mailing Address - Fax:716-373-0992
Practice Address - Street 1:2216 W STATE ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-1922
Practice Address - Country:US
Practice Address - Phone:716-373-0991
Practice Address - Fax:716-373-0992
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133750207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00523973Medicaid
I30212Medicare ID - Type Unspecified
NY00523973Medicaid