MEDICARE: DR. DENNIS R BALES O.D.

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
1	152W00000X	Optometrist	5812T	CA
2	152WC0802X	Corneal and Contact Management Optometrist	5812T	CA

General Provider Information

NPI Number	:	1477528099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNIS R BALES O.D.

Provider Business Mailing Address
First Line	:	2040 VIBORG RD
Second Line	:	SUITE 240
City	:	SOLVANG
State	:	CA
Zip	:	93463-2272
Country	:	US
Telephone Number	:	805-688-0707
Fax Number	:	805-693-9839

Provider Business Practice Location Address
First Line	:	2040 VIBORG RD
Second Line	:	SUITE 240
City	:	SOLVANG
State	:	CA
Zip	:	93463-2272
Country	:	US
Telephone Number	:	805-688-0707
Fax Number	:	805-693-9839

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	09/28/2011

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