| NPI | 1316951239 |
|---|---|
| Former Name | C DALE BAHNER |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NE 786) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IA 01551) |
| 152W00000X Optometrist (Licence: MO 002182) | |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2007-11-07 |