Provider Demographics
NPI:1629411327
Name:BACHMAN, CALEB JOHN (HIS)
Entity Type:Individual
Prefix:
First Name:CALEB
Middle Name:JOHN
Last Name:BACHMAN
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W 15TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3641
Mailing Address - Country:US
Mailing Address - Phone:405-844-9925
Mailing Address - Fax:405-844-9949
Practice Address - Street 1:700 W 15TH ST STE 1
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3641
Practice Address - Country:US
Practice Address - Phone:405-844-9925
Practice Address - Fax:405-844-9949
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1031237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist