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General NPI Number Information
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NPI Number | 1386804243
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Entity Type | Organization
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Legal Business Name | BAUER VISION CENTER
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Dates
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Enumeration Date | 06/13/2008
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Last Update Date | 07/11/2008
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Provider Practice Location Address
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Address Line | 206 PUTNAM ST
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City | MARIETTA
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State | OH
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Zip | 45750-3042
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Country | US
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Telephone | 740-373-7300
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Fax |
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Provider Business Mailing Address
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Address Line | 206 PUTNAM ST
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City | MARIETTA
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State | OH
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Zip | 45750-3042
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Country | US
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Telephone | 740-373-7300
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Fax |
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Authorized Official
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Title or Position | OPTICIAN
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Name | MR. MARK T BAUER
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Credential |
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Telephone | 740-373-7300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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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 | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 3132-S
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License Number State | OH
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