Provider Demographics
NPI:1669680229
Name:TIMOTHY J BAUER DR OF OPTOMETRY PROFESSIONAL CORPORATION CARBONDALE
Entity Type:Organization
Organization Name:TIMOTHY J BAUER DR OF OPTOMETRY PROFESSIONAL CORPORATION CARBONDALE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:970-963-8286
Mailing Address - Street 1:59 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:CO
Mailing Address - Zip Code:81623-2011
Mailing Address - Country:US
Mailing Address - Phone:970-963-8286
Mailing Address - Fax:970-963-8124
Practice Address - Street 1:59 N 4TH ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:CO
Practice Address - Zip Code:81623-2011
Practice Address - Country:US
Practice Address - Phone:970-963-8286
Practice Address - Fax:970-963-8124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1545152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC802969Medicare PIN
COU46952Medicare UPIN