Provider Demographics
NPI:1528193281
Name:BAUMANN, RICHARD WESLEY (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WESLEY
Last Name:BAUMANN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 878
Mailing Address - Street 2:
Mailing Address - City:GARDNERVILLE
Mailing Address - State:NV
Mailing Address - Zip Code:89410-0878
Mailing Address - Country:US
Mailing Address - Phone:775-782-5129
Mailing Address - Fax:775-782-1980
Practice Address - Street 1:1532 US HIGHWAY 395 N
Practice Address - Street 2:SUITE 10
Practice Address - City:GARDNERVILLE
Practice Address - State:NV
Practice Address - Zip Code:89410-5266
Practice Address - Country:US
Practice Address - Phone:775-782-5129
Practice Address - Fax:775-782-1980
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV136152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV0216940001Medicare NSC
NVT67137Medicare UPIN