Provider Demographics
NPI:1407963168
Name:BATHJE, STEVEN A (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:A
Last Name:BATHJE
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 1:202 W ADAMS ST
Mailing Address - Street 2:P.O.BOX 352
Mailing Address - City:IRON RIVER
Mailing Address - State:MI
Mailing Address - Zip Code:49935-1433
Mailing Address - Country:US
Mailing Address - Phone:906-265-9948
Mailing Address - Fax:906-265-9940
Practice Address - Street 1:202 W ADAMS ST
Practice Address - Street 2:
Practice Address - City:IRON RIVER
Practice Address - State:MI
Practice Address - Zip Code:49935-1433
Practice Address - Country:US
Practice Address - Phone:906-265-9948
Practice Address - Fax:906-265-9940
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002844152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2783181Medicaid
MI2783181Medicaid