Provider Demographics
NPI:1679631006
Name:BAILEY, MAX E (OD)
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:E
Last Name:BAILEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2517 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-5867
Mailing Address - Country:US
Mailing Address - Phone:765-966-2661
Mailing Address - Fax:765-965-4789
Practice Address - Street 1:2517 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-5867
Practice Address - Country:US
Practice Address - Phone:765-966-2661
Practice Address - Fax:765-965-4789
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001825B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100256140Medicaid
T69309Medicare UPIN
IN100256140Medicaid