Provider Demographics
NPI:1154590107
Name:STEVEN A BATHJE OD
Entity type:Organization
Organization Name:STEVEN A BATHJE OD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BATHJE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:906-265-9948
Mailing Address - Street 1:202 W ADAMS ST
Mailing Address - Street 2:BOX 352
Mailing Address - City:IRON RIVER
Mailing Address - State:MI
Mailing Address - Zip Code:49935-1433
Mailing Address - Country:US
Mailing Address - Phone:906-265-9948
Mailing Address - Fax:906-265-9940
Practice Address - Street 1:202 W ADAMS ST
Practice Address - Street 2:BOX 352
Practice Address - City:IRON RIVER
Practice Address - State:MI
Practice Address - Zip Code:49935-1433
Practice Address - Country:US
Practice Address - Phone:906-265-9948
Practice Address - Fax:906-265-9940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002844332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0373250001Medicare NSC