Individual
MR. TIMOTHY THOMAS BAUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OPTICIAN
Contact information
Practice address
2049 W PROSPECT RD, ASHTABULA, OH 44004-6437
(440) 992-4877
(801) 459-8867
Mailing address
2049 W PROSPECT RD, ASHTABULA, OH 44004-6437
(440) 992-4877
(801) 459-8867
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
1996-SC
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
341707982-001
MEDICAL MUTUAL OHIO
OH
Enumeration date
01/24/2007
Last updated
07/07/2008
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