Healthcare Provider Details

I. General information

NPI: 1912296443
Provider Name (Legal Business Name): DAVID W. BAILEY MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2216 W STATE ST
OLEAN NY
14760-1922
US

IV. Provider business mailing address

2216 W STATE ST
OLEAN NY
14760-1922
US

V. Phone/Fax

Practice location:
  • Phone: 716-373-0991
  • Fax: 716-373-0992
Mailing address:
  • Phone: 716-373-0991
  • Fax: 716-373-0992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number133750
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier00523973
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name: DAVID WITTNER BAILEY
Title or Position: PRESEDENT
Credential: M.D.
Phone: 716-373-0991