Healthcare Provider Details

I. General information

NPI: 1386804243
Provider Name (Legal Business Name): BAUER VISION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2008
Last Update Date: 07/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 PUTNAM ST
MARIETTA OH
45750-3042
US

IV. Provider business mailing address

206 PUTNAM ST
MARIETTA OH
45750-3042
US

V. Phone/Fax

Practice location:
  • Phone: 740-373-7300
  • Fax:
Mailing address:
  • Phone: 740-373-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number3132-S
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. MARK T BAUER
Title or Position: OPTICIAN
Credential:
Phone: 740-373-7300