Provider Demographics
NPI:1720456288
Name:CHARLES J BAUS, OD AN OPTOMETRIC CORPORATION
Entity type:Organization
Organization Name:CHARLES J BAUS, OD AN OPTOMETRIC CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:J
Authorized Official - Last Name:BAUS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:760-776-9767
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-14
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12183 TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty