Provider Demographics
NPI:1215934625
Name:BAUGHMAN, BRADLEY J (OD)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:J
Last Name:BAUGHMAN
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 1:8216 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-1641
Mailing Address - Country:US
Mailing Address - Phone:937-898-2300
Mailing Address - Fax:937-898-2348
Practice Address - Street 1:8216 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-1641
Practice Address - Country:US
Practice Address - Phone:937-898-2300
Practice Address - Fax:937-898-2348
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHT1892152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2201360OtherUHC
OH000000064638OtherANTHEM
OH2298893Medicaid
OH2298893Medicaid
OH000000064638OtherANTHEM
OH7294551Medicare PIN