Healthcare Provider Details

I. General information

NPI: 1366626616
Provider Name (Legal Business Name): BAILEY OPTOMETRY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2007
Last Update Date: 12/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 WASHINGTON ST
NEW CASTLE IN
47362-4355
US

IV. Provider business mailing address

PO BOX 645
NEW CASTLE IN
47362-0645
US

V. Phone/Fax

Practice location:
  • Phone: 765-529-9364
  • Fax: 765-529-2030
Mailing address:
  • Phone: 765-529-9364
  • Fax: 765-529-2030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number18002774B
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number18002774B
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number18002774B
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18002774B
License Number StateIN

VIII. Authorized Official

Name: DR. JENNIFER R BAILEY
Title or Position: DOCTOR/OWNER
Credential: O.D.
Phone: 765-529-9364