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NPI Code Detail

MEDICARE: DR. PETER S. BAE OD

MEDICARE: DR. PETER S. BAE OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristVUT006341NY

General Provider Information

NPI Number : 1245230861
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PETER S. BAE OD
Provider Business Mailing Address
First Line : 103 W KINGSBRIDGE RD
Second Line :
City : BRONX
State : NY
Zip : 10468-3902
Country : US
Telephone Number : 718-432-5555
Fax Number : 718-548-2399
Provider Business Practice Location Address
First Line : 103 W KINGSBRIDGE RD
Second Line :
City : BRONX
State : NY
Zip : 10468-3902
Country : US
Telephone Number : 718-432-5555
Fax Number : 718-548-2399
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2005
Last Update Date : 09/14/2011

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