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General NPI Number Information
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NPI Number | 1518011527
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Entity Type | Organization
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Legal Business Name | DR ROD BAUER OPTOMETRY & CONTACT LENSES LTD
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 09/06/2007
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Provider Practice Location Address
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Address Line | 3050 HWY 69 SUITE A
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City | PRESCOTT
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State | AZ
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Zip | 86301
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Country | US
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Telephone | 928-445-6755
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Fax | 928-445-4827
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Provider Business Mailing Address
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Address Line | 933 SUNLIT DR
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City | PRESCOTT
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State | AZ
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Zip | 86303
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Country | US
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Telephone | 928-445-6755
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Fax | 928-445-4827
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Authorized Official
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Title or Position | PRES
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Name | RODNEY WILLIAM BAUER
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Credential | OD
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Telephone | 928-445-6755
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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 | 014
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License Number State | AZ
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