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General NPI Number Information
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NPI Number | 1730828096
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Entity Type | Individual
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Provider Name | AMMON ALAN BAYSINGER
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Gender | Male
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Dates
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Enumeration Date | 06/03/2022
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Last Update Date | 06/05/2022
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Provider Practice Location Address
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Address Line | 3383 W MAIN ST
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City | THATCHER
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State | AZ
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Zip | 85552-5682
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Country | US
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Telephone | 928-792-4455
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Fax |
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Provider Business Mailing Address
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Address Line | 7962 W TINSLEY PL
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City | PIMA
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State | AZ
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Zip | 85543-0498
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Country | US
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Telephone | 480-822-9862
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | OPT-002581
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License Number State | AZ
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