Provider Demographics
NPI:1336530955
Name:BAUER, JANA (OD)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:
Last Name:BAUER
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 1:10315 SILVERDALE WAY NW
Mailing Address - Street 2:SEARS OPTICAL
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-7670
Mailing Address - Country:US
Mailing Address - Phone:360-698-0284
Mailing Address - Fax:360-698-0284
Practice Address - Street 1:10315 SILVERDALE WAY NW
Practice Address - Street 2:SEARS OPTICAL
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-7670
Practice Address - Country:US
Practice Address - Phone:360-698-0284
Practice Address - Fax:360-698-0284
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-18
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001885152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist