Provider Demographics
NPI:1407051733
Name:BADER, DONALD L (OD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:L
Last Name:BADER
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 1:2025 12TH AVE RD
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-6459
Mailing Address - Country:US
Mailing Address - Phone:208-461-1000
Mailing Address - Fax:
Practice Address - Street 1:2025 12TH AVE RD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-6459
Practice Address - Country:US
Practice Address - Phone:208-461-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID0-920152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1592778Medicare ID - Type Unspecified
IDT46104Medicare UPIN