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General NPI Number Information
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NPI Number | 1194843045
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Entity Type | Organization
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Legal Business Name | THOMAS E BAUER OD AND DIANE S DIBLE OD LLC
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 06/30/2010
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Provider Practice Location Address
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Address Line | 1518 N PERRY ST
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City | OTTAWA
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State | OH
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Zip | 45875-1167
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Country | US
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Telephone | 419-523-5670
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Fax | 419-523-4025
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Provider Business Mailing Address
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Address Line | 1518 N PERRY ST
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City | OTTAWA
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State | OH
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Zip | 45875-1167
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Country | US
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Telephone | 419-523-5670
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Fax | 419-523-4025
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Authorized Official
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Title or Position | MEMBER LLC
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Name | DIANE S DIBLE
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Credential | OD
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Telephone | 419-523-5670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4552 3214
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License Number State | OH
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