Individual
RICK D BAUER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
109 W MAIN ST, LOOGOOTEE, IN 47553-1506
(812) 295-3163
(812) 295-2356
Mailing address
109 W MAIN ST, P O BOX 296, LOOGOOTEE, IN 47553-1506
(812) 295-3163
(812) 295-2356
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18001964
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100175810A
—
IN
01
—
35-1517701
FEDERAL TAX ID
IN
Enumeration date
09/23/2005
Last updated
12/20/2010
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