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General NPI Number Information
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NPI Number | 1891103818
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Entity Type | Individual
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Provider Name | ADELINE BAUER OD
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Gender | Female
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Dates
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Enumeration Date | 07/23/2014
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Last Update Date | 12/01/2022
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Provider Practice Location Address
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Address Line | 4130 BRETON RD SE STE A
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City | KENTWOOD
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State | MI
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Zip | 49512-3808
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Country | US
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Telephone | 616-341-1713
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Fax | 616-341-1714
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Provider Business Mailing Address
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Address Line | 4130 BRETON RD SE STE A
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City | KENTWOOD
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State | MI
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Zip | 49512-3808
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Country | US
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Telephone | 616-341-1713
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Fax | 616-341-1714
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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 | 4901004841
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 4901004841
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License Number State | MI
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