Provider Demographics
NPI:1194701060
Name:BAYLY, NANCY S (OD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:S
Last Name:BAYLY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 260
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:IN
Mailing Address - Zip Code:47978-0260
Mailing Address - Country:US
Mailing Address - Phone:219-866-5661
Mailing Address - Fax:219-866-8705
Practice Address - Street 1:212 S VAN RENSSELAER ST
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:IN
Practice Address - Zip Code:47978-2817
Practice Address - Country:US
Practice Address - Phone:219-866-5661
Practice Address - Fax:219-866-8705
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002094A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN390740Medicare PIN