Provider Demographics
NPI:1598845364
Name:BAUDER, MISTY LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:MISTY
Middle Name:LYNN
Last Name:BAUDER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MISTY
Other - Middle Name:LYNN
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:114 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-1426
Mailing Address - Country:US
Mailing Address - Phone:614-882-0851
Mailing Address - Fax:614-882-2595
Practice Address - Street 1:114 N STATE ST
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-1426
Practice Address - Country:US
Practice Address - Phone:614-882-0851
Practice Address - Fax:614-882-2595
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5662152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5662OtherTHERAPEUTIC OPTOMETRIST
OHT2576OtherTHERAPEUTIC CERTIFICATE #