Provider Demographics
NPI:1609061142
Name:DAVID J BAUMGARDNER, OD PC
Entity Type:Organization
Organization Name:DAVID J BAUMGARDNER, OD PC
Other - Org Name:COLUMBINE VISION CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:BAUMGARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:303-979-6767
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1259152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C457588Medicare PIN