Provider Demographics
NPI:1063758712
Name:BRUCE E. BACHELDER O.D.,LLC
Entity type:Organization
Organization Name:BRUCE E. BACHELDER O.D.,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:BACHELDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-884-0500
Mailing Address - Street 1:35 PLYMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:44904-1123
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:35 PLYMOUTH ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:OH
Practice Address - Zip Code:44904-1123
Practice Address - Country:US
Practice Address - Phone:419-884-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-28
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3012-T185152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHT46631Medicare UPIN