Provider Demographics
NPI:1659706588
Name:BACH, AUSTIN (DO)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:
Last Name:BACH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4330 SHERIDAN ST STE 102B
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-1407
Mailing Address - Country:US
Mailing Address - Phone:954-287-2010
Mailing Address - Fax:305-723-1910
Practice Address - Street 1:4330 SHERIDAN ST STE 102B
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-1407
Practice Address - Country:US
Practice Address - Phone:954-287-2010
Practice Address - Fax:305-723-1910
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS14416207W00000X, 207WX0110X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021585200Medicaid