Individual
MR. CHARLES JEFFREY BAUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
72608 EL PASEO, SUITE 6, PALM DESERT, CA 92260-3373
(760) 776-9767
(760) 776-9333
Mailing address
72608 EL PASEO, SUITE 6, PALM DESERT, CA 92260-3373
(760) 776-9767
(760) 776-9333
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
12183T
CA
152WC0802X
Corneal and Contact Management Optometrist
OPT12183
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0313520001
DMERC M/C REGION D
CA
01
—
GSD004460
MEDICAID GROUP NUMBER
CA
05
—
SD0121830
—
CA
01
—
ZZZ24908Z
MEDICARE GROUP NUMBER
CA
Enumeration date
11/30/2005
Last updated
08/25/2014
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