Provider Demographics
NPI:1215911565
Name:BAUS, CHARLES JEFFREY (OD)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:JEFFREY
Last Name:BAUS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72608 EL PASEO
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-3373
Mailing Address - Country:US
Mailing Address - Phone:760-776-9767
Mailing Address - Fax:760-776-9333
Practice Address - Street 1:72608 EL PASEO
Practice Address - Street 2:SUITE 6
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-3373
Practice Address - Country:US
Practice Address - Phone:760-776-9767
Practice Address - Fax:760-776-9333
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT12183152WC0802X
CA12183T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSD004460OtherMEDICAID GROUP NUMBER
CAZZZ24908ZOtherMEDICARE GROUP NUMBER
CASD0121830Medicaid
CA0313520001OtherDMERC M/C REGION D
CASD0012183Medicare ID - Type Unspecified
CA1215911565Medicare NSC
CAZZZ24908ZOtherMEDICARE GROUP NUMBER
CAU92857Medicare UPIN