Provider Demographics
NPI:1477528099
Name:BALES, DENNIS R (OD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:R
Last Name:BALES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2040 VIBORG RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:SOLVANG
Mailing Address - State:CA
Mailing Address - Zip Code:93463-2272
Mailing Address - Country:US
Mailing Address - Phone:805-688-0707
Mailing Address - Fax:805-693-9839
Practice Address - Street 1:2040 VIBORG RD
Practice Address - Street 2:SUITE 240
Practice Address - City:SOLVANG
Practice Address - State:CA
Practice Address - Zip Code:93463-2272
Practice Address - Country:US
Practice Address - Phone:805-688-0707
Practice Address - Fax:805-693-9839
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5812T152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU29309Medicare UPIN
CA0819900001Medicare NSC
CAOP5812Medicare PIN