Individual
HENRY BAUSBACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2203 61ST ST W, BRADENTON, FL 34209-5528
(941) 792-2020
Mailing address
PO BOX 11407, BIRMINGHAM, AL 35246-8575
(864) 359-1308
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
18002622A
IN
152W00000X
Optometrist
Primary
OPC-5052
FL
207W00000X
Ophthalmology Physician
OPC5052
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100376610
—
IN
Enumeration date
01/23/2006
Last updated
04/15/2026
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