Provider Demographics
NPI:1770006504
Name:BAUM, RACHEL LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:LYNN
Last Name:BAUM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 US HIGHWAY 27 S
Mailing Address - Street 2:
Mailing Address - City:BERNE
Mailing Address - State:IN
Mailing Address - Zip Code:46711-2006
Mailing Address - Country:US
Mailing Address - Phone:260-589-2020
Mailing Address - Fax:260-589-3068
Practice Address - Street 1:305 US HIGHWAY 27 S
Practice Address - Street 2:
Practice Address - City:BERNE
Practice Address - State:IN
Practice Address - Zip Code:46711-2006
Practice Address - Country:US
Practice Address - Phone:260-589-2020
Practice Address - Fax:260-589-3068
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004032A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist