| NPI | 1306943436 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HENRY BAUSBACK Optometrist 219-878-5021 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 207W00000X Ophthalmology |
| 332H00000X Eyewear Supplier (Equipment, not the service) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2011-07-01 |