Provider Demographics
NPI:1386827186
Name:NANCY S. BAYLY, OD PC
Entity type:Organization
Organization Name:NANCY S. BAYLY, OD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:S
Authorized Official - Last Name:BAYLY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:219-866-5661
Mailing Address - Street 1:PO BOX 260
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:IN
Mailing Address - Zip Code:47978-2433
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:47978-2433
Practice Address - Country:US
Practice Address - Phone:219-866-5661
Practice Address - Fax:219-866-8705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002094B152W00000X
IN18002094A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0475150001Medicare PIN
IN0475150001Medicare NSC
INU28149Medicare UPIN