Provider Demographics
NPI:1972508067
Name:BAUER SKELLEY, HEIDI (OD)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:
Last Name:BAUER SKELLEY
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:PO BOX 5649
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-0649
Mailing Address - Country:US
Mailing Address - Phone:989-797-2400
Mailing Address - Fax:989-249-1035
Practice Address - Street 1:5161 CARDINAL PARK DRIVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-9435
Practice Address - Country:US
Practice Address - Phone:989-797-2400
Practice Address - Fax:989-249-1035
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI003855152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI9404091424Medicaid
MIU77907Medicare UPIN
MIM90930010Medicare ID - Type UnspecifiedMEDICARE