Provider Demographics
NPI:1174570451
Name:BAXTER, RICHARD WHITNEY (OD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WHITNEY
Last Name:BAXTER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:210 PINEHURST DRIVE SW
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-5237
Mailing Address - Country:US
Mailing Address - Phone:360-357-3410
Mailing Address - Fax:360-357-5652
Practice Address - Street 1:5164 CAPITOL BLVD SE
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-4442
Practice Address - Country:US
Practice Address - Phone:360-357-3410
Practice Address - Fax:360-357-5652
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1530 TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2098002Medicare ID - Type Unspecified
WAT00401Medicare UPIN
WA10000078Medicare ID - Type UnspecifiedMEDICARE ID #