Individual
JASON BACHARACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
104 LYNCH CREEK WAY, SUITE 15, PETALUMA, CA 94954-2355
(707) 762-3573
(707) 762-6873
Mailing address
104 LYNCH CREEK WAY, SUITE 15, PETALUMA, CA 94954-2355
(707) 762-3573
(707) 762-6873
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
G73984
CA
207WX0009X
Glaucoma Specialist (Ophthalmology) Physician
Primary
G73984
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
180025762
PALMETTO GBA
CA
05
—
G73984
—
CA
Enumeration date
11/02/2005
Last updated
03/07/2023
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