Healthcare Provider Details

I. General information

NPI: 1689432064
Provider Name (Legal Business Name): JOHN BAUMER II OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JACK BAUMER OD

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 SPRINGSIDE DR
AKRON OH
44333-2468
US

IV. Provider business mailing address

150 SPRINGSIDE DR
AKRON OH
44333-2468
US

V. Phone/Fax

Practice location:
  • Phone: 330-666-0707
  • Fax: 330-668-4884
Mailing address:
  • Phone: 330-666-0707
  • Fax: 330-668-4884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.007265
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: