Individual
ANDREW J BALDUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1700 W PARADISE DR, WEST BEND, WI 53095-9795
(414) 454-7734
Mailing address
1700 W PARADISE DR, WEST BEND, WI 53095-9795
(414) 454-7734
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2616
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0474980001
DMERC-MEDFORD GROUP
WI
01
—
10445
NVA-MEDFORD
WI
01
—
1271670001
DMERC-COLBY GROUP
WI
01
—
2616
LICENSE
WI
05
—
38596900
—
WI
05
—
38715100
—
WI
05
—
38715300
—
WI
01
—
39-1229699
FEDERAL TAX ID-MEDFORD
WI
01
—
39-1967186
FEDERAL TAX ID-COLBY
WI
01
—
391229699015
BLUE CROSS BLUE SHIELD-ME
WI
01
—
391967186019
BLUE CROSS BLUE SHIELD-CO
WI
01
—
410046659
RAILROAD MEDICARE-MEDFORD
WI
01
—
410046660
RAILROAD MEDICARE-COLBY
WI
01
—
74812
SECURITY HEALTH PLAN-COLB
WI
01
—
74813
SECURITY HEALTH PLAN-MEDF
WI
Enumeration date
12/28/2005
Last updated
10/17/2023
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