Provider Demographics
NPI:1457356297
Name:BAUMAN, MICHAEL BRIGGS (OD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BRIGGS
Last Name:BAUMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:BRIGGS
Other - Last Name:BAUMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:415 PINEY FOREST RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-4044
Mailing Address - Country:US
Mailing Address - Phone:434-793-2020
Mailing Address - Fax:434-792-0102
Practice Address - Street 1:415 PINEY FOREST RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-4044
Practice Address - Country:US
Practice Address - Phone:434-793-2020
Practice Address - Fax:434-792-0102
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2018-03-17
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
VA0601001852152W00000X
VA618000253152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA807898100Medicaid