Individual
ADELINE BAUER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
4130 BRETON RD SE STE A, KENTWOOD, MI 49512-3808
(616) 341-1713
(616) 341-1714
Mailing address
4130 BRETON RD SE STE A, KENTWOOD, MI 49512-3808
(616) 341-1713
(616) 341-1714
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
4901004841
MI
152WC0802X
Corneal and Contact Management Optometrist
Primary
4901004841
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0784610001
MEDICARE NSC
MI
05
—
1871510859
—
MI
01
—
900E476020
BLUE CROSS
MI
Enumeration date
07/23/2014
Last updated
12/01/2022
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