Individual provider Active NPI

William Gary Bachman, OD

  • Optometrist
  • Saint Louis, MO
National Provider Identifier
1295847507
Registry record updated Sep 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
T02108 Issued in MO
Practice address
7800 Natural Bridge Rd
1 University Blvd
Saint Louis, MO 63121-4617
Phone
(314) 516-5131
Fax
(314) 516-5507
NPI assigned
Aug 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X T02108 MO Primary

Addresses

Primary practice location

7800 Natural Bridge Rd
1 University Blvd
Saint Louis, MO 63121-4617

Mailing address

One University Blvd
115 Marillac Hall
St Louis, MO 63121
Phone (314) 516-5131

Other identifiers 1

IdentifierTypeStateIssuer
1295847507MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
T02108MOMDOptometrist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316476800000",
    "number": "1295847507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "ONE UNIVERSITY BLVD",
            "address_2": "115 MARILLAC HALL",
            "city": "ST LOUIS",
            "state": "MO",
            "postal_code": "63121",
            "telephone_number": "314-516-5131",
            "fax_number": "314-516-5507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7800 NATURAL BRIDGE RD",
            "address_2": "1 UNIVERSITY BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631214617",
            "telephone_number": "314-516-5131",
            "fax_number": "314-516-5507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACHMAN",
        "first_name": "WILLIAM",
        "middle_name": "GARY",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2011-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "T02108",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1295847507",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.