Healthcare Provider Details

I. General information

NPI: 1285695585
Provider Name (Legal Business Name): DENA L BACHMAN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N MAPLE ST
BRIGHTON IL
62012-1053
US

IV. Provider business mailing address

101 N MAPLE ST
BRIGHTON IL
62012-1053
US

V. Phone/Fax

Practice location:
  • Phone: 618-372-7000
  • Fax: 618-371-7003
Mailing address:
  • Phone: 618-372-7000
  • Fax: 618-371-7003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046008614
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: