Provider Demographics
NPI:1285695585
Name:BACHMAN, DENA L (OD)
Entity type:Individual
Prefix:DR
First Name:DENA
Middle Name:L
Last Name:BACHMAN
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 1:101 N MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:IL
Mailing Address - Zip Code:62012-1053
Mailing Address - Country:US
Mailing Address - Phone:618-372-7000
Mailing Address - Fax:618-371-7003
Practice Address - Street 1:101 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:IL
Practice Address - Zip Code:62012-1053
Practice Address - Country:US
Practice Address - Phone:618-372-7000
Practice Address - Fax:618-371-7003
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008614152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU43513OtherMERCY
IL046008614Medicaid
IL128048OtherGHP
IL168095OtherCOLE
IL4040370OtherBCBS
INU43513OtherMERCY
INIL8614OtherEYE MED
IL2280644OtherUHC
IL438769OtherHEALTHLINK
IL5075438OtherAETNA
IL438769OtherHEALTHLINK
IL5075438OtherAETNA
IL046008614Medicaid
IL410049466Medicare ID - Type UnspecifiedRRMEDICARE