Provider Demographics
NPI:1558423731
Name:BAHR, KEVIN LEE (OD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:LEE
Last Name:BAHR
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:20 LAKE ST N
Mailing Address - Street 2:#104
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-2523
Mailing Address - Country:US
Mailing Address - Phone:651-464-4824
Mailing Address - Fax:651-464-0003
Practice Address - Street 1:20 LAKE ST N
Practice Address - Street 2:#104
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-2523
Practice Address - Country:US
Practice Address - Phone:651-464-4824
Practice Address - Fax:651-464-0003
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN2070000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist