Provider Demographics
NPI:1518011527
Name:DR ROD BAUER OPTOMETRY & CONTACT LENSES LTD
Entity Type:Organization
Organization Name:DR ROD BAUER OPTOMETRY & CONTACT LENSES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:928-445-6755
Mailing Address - Street 1:933 SUNLIT DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303
Mailing Address - Country:US
Mailing Address - Phone:928-445-6755
Mailing Address - Fax:928-445-4827
Practice Address - Street 1:3050 HWY 69
Practice Address - Street 2:SUITE A
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301
Practice Address - Country:US
Practice Address - Phone:928-445-6755
Practice Address - Fax:928-445-4827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ014152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T41382Medicare UPIN
AZZ78826Medicare PIN