Thomas Edward Bauer, OD
Individual provider Active NPI Optometrist · Ottawa, OH
NPI 1285704668 · NPPES record last updated Jun 10, 2010
Key facts
- NPI
- 1285704668
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 3214T346 (OH)
- Practice address
- 1518 N Perry St
Ottawa, OH 45875-1167 - Phone
- (419) 523-5670
- Fax
- (419) 523-4025
- NPI assigned
- Nov 9, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3214T346 | OH | MD | Optometrist |
| 3214 | OH | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lima Memorial Joint Operating Company | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 3214T346 | OH | Yes |
Addresses
Primary practice location
1518 N Perry St
Ottawa, OH 45875-1167
Mailing address
1518 N Perry St
Ottawa, OH 45875-1167
Phone (419) 523-5670
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 410046675 | Other | RAILROAD MEDICARE |
Other providers in Ottawa, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 10, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.