Provider Demographics
NPI:1730828096
Name:BAYSINGER, AMMON ALAN
Entity type:Individual
Prefix:
First Name:AMMON
Middle Name:ALAN
Last Name:BAYSINGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7962 W TINSLEY PL
Mailing Address - Street 2:
Mailing Address - City:PIMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85543-0498
Mailing Address - Country:US
Mailing Address - Phone:480-822-9862
Mailing Address - Fax:
Practice Address - Street 1:3383 W MAIN ST
Practice Address - Street 2:
Practice Address - City:THATCHER
Practice Address - State:AZ
Practice Address - Zip Code:85552-5682
Practice Address - Country:US
Practice Address - Phone:928-792-4455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-03
Last Update Date:2022-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOPT-002581152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist