Provider Demographics
NPI:1740283944
Name:BAILEY, DAN (OD)
Entity type:Individual
Prefix:
First Name:DAN
Middle Name:
Last Name:BAILEY
Suffix:
Gender:M
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 426
Mailing Address - Street 2:
Mailing Address - City:BURNET
Mailing Address - State:TX
Mailing Address - Zip Code:78611-0426
Mailing Address - Country:US
Mailing Address - Phone:512-756-2131
Mailing Address - Fax:512-756-7831
Practice Address - Street 1:2801 S WATER ST
Practice Address - Street 2:
Practice Address - City:BURNET
Practice Address - State:TX
Practice Address - Zip Code:78611-4515
Practice Address - Country:US
Practice Address - Phone:512-756-2131
Practice Address - Fax:512-756-7831
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX02223TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121620205Medicaid
TXP00394701OtherPALMETTO GBA RAILROAD MED
TX121620205Medicaid
TX8J5396Medicare PIN
TXT12029Medicare UPIN