Provider Demographics
NPI:1912296443
Name:DAVID W. BAILEY MD PC
Entity Type:Organization
Organization Name:DAVID W. BAILEY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESEDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WITTNER
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-373-0991
Mailing Address - Street 1:2216 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-1922
Mailing Address - Country:US
Mailing Address - Phone:716-373-0991
Mailing Address - Fax:716-373-0992
Practice Address - Street 1:2216 W STATE ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-1922
Practice Address - Country:US
Practice Address - Phone:716-373-0991
Practice Address - Fax:716-373-0992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133750261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00523973Medicaid
NY00523973Medicaid