Individual
JON BAUSBACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1225 E COOLSPRING AVE, MICHIGAN CITY, IN 46360-6312
(219) 878-5021
(219) 878-5002
Mailing address
1040 SIERRA DR, STE 400, GREENWOOD, IN 46143-7240
(317) 528-4248
(317) 865-8314
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18001410A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200112890
—
IN
Enumeration date
01/25/2006
Last updated
11/16/2011
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