Provider Demographics
NPI:1770746315
Name:BAUERNFIEND, JOAN RENAE (OD)
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:RENAE
Last Name:BAUERNFIEND
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9412 E STATE ROAD 64
Mailing Address - Street 2:APT A
Mailing Address - City:VELPEN
Mailing Address - State:IN
Mailing Address - Zip Code:47590-8857
Mailing Address - Country:US
Mailing Address - Phone:812-631-1888
Mailing Address - Fax:
Practice Address - Street 1:255 W 36TH ST
Practice Address - Street 2:STE. 240
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-7849
Practice Address - Country:US
Practice Address - Phone:812-481-2100
Practice Address - Fax:812-481-2144
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003529A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist