MEDICARE: DAVID J BAUMGARDNER, OD PC

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	1259	CO

General Provider Information

NPI Number	:	1609061142
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID J BAUMGARDNER, OD PC

Provider Business Mailing Address
First Line	:	6638 W OTTAWA AVE
Second Line	:	SUITE 235
City	:	LITTLETON
State	:	CO
Zip	:	80128-4562
Country	:	US
Telephone Number	:	303-979-6767
Fax Number	:	303-972-7422

Provider Business Practice Location Address
First Line	:	6638 W OTTAWA AVE
Second Line	:	SUITE 235
City	:	LITTLETON
State	:	CO
Zip	:	80128-4562
Country	:	US
Telephone Number	:	303-979-6767
Fax Number	:	303-972-7422

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. DAVID J BAUMGARDNER
Credential	:	OD
Telephone Number	:	303-979-6767

Provider Enumeration Date	:	09/07/2007
Last Update Date	:	11/09/2007

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