Provider Demographics
NPI:1497710768
Name:BAUMGARDNER, DAVID JEFFREY (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JEFFREY
Last Name:BAUMGARDNER
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 1:6638 W OTTAWA AVE
Mailing Address - Street 2:SUITE 235
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80128-4562
Mailing Address - Country:US
Mailing Address - Phone:303-979-6767
Mailing Address - Fax:303-972-7422
Practice Address - Street 1:6638 W OTTAWA AVE
Practice Address - Street 2:SUITE 235
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80128-4562
Practice Address - Country:US
Practice Address - Phone:303-979-6767
Practice Address - Fax:303-972-7422
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1259152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
C457598Medicare PIN