Provider Demographics
NPI:1417953498
Name:BAUMANN, MICHAEL WILLIAM (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WILLIAM
Last Name:BAUMANN
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 1:112 N AKERS ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-5121
Mailing Address - Country:US
Mailing Address - Phone:559-733-4372
Mailing Address - Fax:559-733-1758
Practice Address - Street 1:112 N AKERS ST
Practice Address - Street 2:SUITE A
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-5121
Practice Address - Country:US
Practice Address - Phone:559-733-4372
Practice Address - Fax:559-733-1758
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 8061152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT 8061OtherCA LICENSE NUMBER
CASD0080610Medicaid
CASD0080610OtherBLUE SHIELD PROVIDER ID#
CAGSD005170Medicaid
CAGSD005170Medicaid
CAOPT 8061OtherCA LICENSE NUMBER
CASD0080610OtherBLUE SHIELD PROVIDER ID#