Provider Demographics
NPI:1700910775
Name:BAO CHE
Entity Type:Organization
Organization Name:BAO CHE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BAO
Authorized Official - Middle Name:
Authorized Official - Last Name:CHE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:978-531-7217
Mailing Address - Street 1:300 ANDOVER ST
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-1526
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 ANDOVER ST
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-1526
Practice Address - Country:US
Practice Address - Phone:978-531-7217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4517152W00000X
NH0774152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW20412OtherBCBSMA GROUP #
MAW21090Medicare ID - Type Unspecified